PHYSICAL ABUSE AND NEGLECT

Child abuse and neglect is a social problem faced by individuals and societies around the world; however, few works exist that compare this problem across national boundaries. The International Society for the Prevention of Child Abuse and Neglect (IPSCAN) is an international organization focused on prevention and treatment issues associated with child abuse and neglect, and provides researchers in a number of disciplines with the opportunity to communicate about global issues of child abuse. One forum for this communication is Child Abuse and Neglect: The International Journal. One text, Child Abuse: A Global Perspective, by Beth Schwartz-Kenney, Michelle McCauley, and Michelle Epstein (2001), takes an extensive global view of all areas of child abuse among sixteen countries worldwide. This comparative perspective describes the nature of child abuse within each country and the countries' responses to abuse with regard to prevention and treatment.

Defining Child Physical Abuse and Neglect

The definition of abuse and neglect is difficult to determine even within a particular country. For example, Joaquín De Paúl and Olaya González (2001) note that before 1987 professionals in Spain could not reach an agreement concerning how one should classify child maltreatment cases: There was no commonly used definition of child abuse and neglect. Given the many cultural and societal influences affecting the way in which a country defines abuse, defining abuse globally is obviously a formidable task, although definitions of abuse and neglect do contain commonalities across countries. Child maltreatment includes both the abuse and neglect of a child, two different types of problems with slightly different causes, perpetrators, and outcomes. Furthermore, abuse occurs in a number of different forms including physical abuse, psychological maltreatment, and sexual abuse. These categorizations of abuse are fairly common across cultures.

Physical abuse often is described as a situation in which a child sustains injury due to the willful acts of an adult. This type of abuse can be defined very loosely, where abuse is defined as the illtreatment of children. However, the definition may be as specific as stating that the injuries are inflicted by particular acts such as hitting, biting, kicking, or slapping; and/or occur through the use of objects such as belts, sticks, rods, or bats. These more specific definitions are usually the result of laws created to protect children. For instance in Spain the 21/87 Act improved the consistency of definitions used throughout the country in identifying child abuse (De Paúl and González 2001). In Israel in 1989 an amendment was passed known as the Law for the Prevention of Abuse of Minors and the Helpless. Specific types of abuse were defined within this amendment, creating a more definitive classification of each type of abuse in Israel (Cohen 2001). In many countries, the definition of physical abuse involves the presence of a physical mark created by intentional physical contact by an adult. One advantage of clear definitions is that they result in a more accurate reporting of physical abuse to authorities (Kasim 2001).

Physical abuse can also be a result of parental and/or school discipline in which a child is punished by beating or other forms of corporal punishment. It should be noted, however, that there are large cultural differences in the interpretation of corporal punishment as abuse. Many Western countries classify corporal punishment of any kind as physical abuse, although this is not true for the United States or Canada. In fact, twenty-three U.S. states allow corporal punishment in the public school system (National Coalition to Abolish Corporal Punishment in Schools 2001). Corporal punishment of children is also accepted in other countries. In Sri Lanka, caning a child is still a permitted form of punishment in government schools, and parents and teachers believe they have the right to impose corporal punishment (de Silva 2001). This is also the case in Kenya, where physical punishment is an acceptable way of disciplining children (Onyango and Kattambo 2001). In Romania 96 percent of the population are comfortable with beating a child as a form of discipline and do not feel that this beating would have any negative impact on the child's development (Muntean and Roth 2001). In India, Uma Segal (1995) examined the incidence of physical abuse defined as "discipline." Her results indicate that 57.9 percent of parents stated that they had engaged in "normal" corporal punishment, 41 percent in "abusive" discipline, and 2.9 percent in "extreme" discipline.

Physical abuse also includes acts of exploitation. This type of physical abuse is prevalent in a number of countries such as Sri Lanka, the Philippines, and Thailand where sexual exploitation of children is well documented (de Silva 2001). Exploitation is also seen in the form of child labor in a number of countries, such as India (Segal 2001), and in the conscription into the military of children in Sri Lanka (de Silva 2001). Finally, one less common form of psychical abuse results when a caretaker fabricates a child's illness, known as Munchausen Syndrome by Proxy. The pattern of events accompanying this syndrome often results in physical injury to the child (Wiehe 1996). Munchausen Syndrome by Proxy has been identified in a number of different countries (Schwartz-Kenney, Mc-Cauley, and Epstein 2001).

In the United States, following C. Henry Kempe and his colleagues' (1962) identification of battered-child syndrome, physical abuse was identified more objectively through the use of medical definitions. The Child Abuse Prevention and Treatment Act of 1974 led to a federal definition of child abuse and neglect. This Act provided definitions for all types of abuse and led to greater public awareness and response to problems associated to child maltreatment. This federal definition was changed in 1996 by the U.S. Congress. Child abuse and neglect in the United States is now defined as ". . . any recent act or failure to act on the part of a parent or caretaker, which results in the death, serious physical or emotional harm, sexual abuse or exploitation, or an act or failure to act which present an imminent risk of serious harm" (42 U.S.C. §5106g[2] [1999]). This change gave greater discretion to the states, allowing each state to define abuse more broadly.

Child neglect also can take on a number of different forms. For instance a child's nutritional needs can be ignored, resulting in a deficient diet and, in turn, a "failure to thrive." This nutritional neglect is not necessarily intentional and may result from a parent's lack of knowledge regarding a healthy diet or from poverty. Physical neglect results when a child is not provided with adequate food, shelter, and clothing. Neglect can also come in the form of inadequate medical care, lack of proper supervision, and lack of educational opportunities. Finally, neglect also includes inadequate emotional care, where a child experiences a continuous lack of response to his or her crying or any other behavior in need of a response.

The type of neglect experienced by children is dependent upon the culture in which one lives. For instance, in India one problem still faced by many young women is child marriage. Due to extreme poverty, many girls are perceived as a financial burden to their families and are in turn forced to marry in exchange for money. In some cases, young women are sold to brothels. As Segal (2001) notes, under both circumstances these children are inevitably physically abused.

A very distinct type of neglect occurs in Japan, where coin-operated lockers have been a part of the problem. For years, unwanted children were placed in these lockers and, in many cases, died when not found in time. This became a serious social problem in the mid-1970s. According to Akihisa Kouno and Charles Felzen Johnson (1995), approximately 7 percent of infanticides in Japan during this period were of coin-operated locker babies. Since that time, this type of neglect has dropped dramatically due to an increase in locker inspection and relocation and to educational programs on contraception.

Abuse and neglect in Romania often takes the form of child abandonment, believed to be due to poverty, lack of education, and lack of assistance to families in need (Muntean and Roth 2001). Additional abuse and neglect takes place within the family given the existing living conditions. Ana Muntean and Maria Roth state that the "emotional, physical, and even sexual abuse is quite frequent within the Romanian-family system, as well as neglect" (p. 185).

Differences in prevalence of particular subtypes of abuse are therefore evident when examining child maltreatment from an international perspective. Although evidence of abuse can be found in all countries, how abuse is defined, prevented, and treated is often determined by social agencies such as the U.S. Department of Health. The definition itself is dependent upon the national boundaries in which the agency exists. One common thread within the prevalence data in most countries is that the individuals responsible for collecting these data often state that it is likely that the numbers underestimate the degree of child abuse due to the underreporting of incidents to legal authorities (Schwartz-Kenney, McCauley, and Epstein 2001).

Prevalence of Abuse and Neglect

Internationally, child abuse is more common than previously acknowledged. Historically, it was hard for many to believe that parents or caregivers would intentionally inflict harm towards their children. Thus, in many countries child abuse and neglect were often ignored or denied as a result of people's acceptance of violence in a given culture or due to their belief that the culture must focus on preserving the family (Schwartz-Kenney, Mc-Cauley, and Epstein 2001). Some cultures simply denied that child neglect or abuse occurred. For example, Mohd Sham Kasim (2001) states that in Malaysia the problem of abuse was at one time believed to be a problem only for Western cultures. This stemmed from the idea that the strong family ties and assistance from the extended family prevalent in Malaysia prevented the problem from occurring.

Internationally, it has always been the case that the culture had to acknowledge the problem of neglect and abuse before national organizations concerned with prevention and treatment could be created. Unfortunately, it took many years (often decades) before many societies recognized it as a problem worthy of governmental resources. As mentioned above, the noted physician C. Henry Kempe dramatically increased many countries' public awareness regarding the abuse and neglect of children in his lectures on the battered-child syndrome (Kempe et al. 1962).

The prevalence of each type of maltreatment is a question that can be answered in some countries but not others. For example, this type of data is available in the United States, Australia, Malaysia, and Ireland. Other countries, such as Canada, are studying this question, whereas others, such as Mexico and Romania, are grappling with how to identify children in need rather than placing their resources in the assessment of prevalence rates for each type of abuse. When comparing countries in which the numbers are available, it is evident that there are differences with regard to the prevalence of each type of abuse. For instance, in Australia, 31 percent of reports were of emotional abuse, 28 percent included physical abuse, 16 percent consisted of sexual abuse, and 24 percent represented neglect (Hatty and Hatty 2001). This is compared to the prevalence reports in Ireland, where 34 percent of reports involved sexual abuse, 8 percent included emotional abuse, 11 percent were identified as physical abuse, and 47 percent were of neglect (Ferguson 2001). In the United States, the Child Protective Services (CPS) state that neglect is the most prevalent type of maltreatment, accounting for 45 percent of all reports, followed by physical abuse in 25 percent of cases, sexual abuse in 16 percent of cases, and finally psychological abuse in 6 percent of all reports (Briere et al. 1996).

Thus, cultural differences significantly influence the way in which forms of abuse are defined and in turn the prevalence rates that result. Given differences in defining abuse, it is not surprising that the prevalence numbers such as those reported above differ dramatically from one country to the next. For instance, as Kouno and Johnson (2001) indicate, "the disparity between prevalence rates of report abuse cases in the United States and Japan may be the result of differences in lifestyle and reporting laws between Western countries and Japan" (pp. 102–103). Comparing abuse from one country to the next is a difficult task given the differences in definition, lifestyle, and legal system. In all cases, authorities believe the prevalence rates represent approximately one-third of all cases of child abuse because these statistics are based only on reported cases and therefore ignore the remaining two-thirds of all occurrences of maltreatment. With the introduction of mandatory reporting laws in numerous countries, however, these numbers are rising. In addition, an increase in public awareness of the problem of abuse and neglect directly relates to an increase in reporting of abuse to authorities.

Perpetrators and Families in which Neglect Occurs

Who is more likely to neglect a child? Researchers have examined the characteristics of families often associated with neglect. One finding is that the perpetrator of neglect in the United States and other Western countries is likely to be female (Ferguson 2001; Juvenile Justice Bulletin 1999). This may be a function of the fact that neglect is more likely to occur in single-parent families and homes in which the mother is young. Children born to women under the age of twenty in the United States are 3.5 times more likely to experience neglect and abuse than children born to older mothers (Lee and Goerge 1999). In addition, neglect occurs more often in families with mothers who are childlike in nature—for instance, those who are more dependent on others, act more impulsively, cannot assume responsibility for themselves or others, and show poor judgment. These mothers often receive very little social support, were neglected as children themselves, have higher rates of depression than the overall population, experience high degrees of stress, and were part of families that lived in environments that did not provide adequate mental and health services or educational facilities (Wiehe 1996). Domestic abuse has also been found related to maternal neglect in Western countries such as Ireland (Ferguson 2001) and the United States (Briere et al. 1996). Researchers have also found that children born to substance abusers are more likely to experience neglect and injury compared to children of non-substance abusers (Bijur et al. 1992). Concerning family factors, children of neglect were most often from families living in poverty, families without a father present (Ferguson 2001; Polansky et al. 1981) or with an unemployed male adult (Hawkins and Dunkin 1985), families with four or more children ( Juvenile Justice Bulletin 1999), and families in which the interaction between the children and adults was primarily negative (Wiehe 1996). All of these factors often lead to a parent's inability to adequately parent, resulting in neglect of one form or another.

Perpetrators and Families in which Physical Abuse Occurs

Researchers have identified a number of factors associated with the physical abuse of a child, such as the characteristics of individuals who abuse and the characteristics of families in which child abuse occurs. In the United States less than 10 percent of child abuse is committed by non-family members ( Juvenile Justice Bulletin 1999). Obviously, the non-family abuse rate may be higher in countries such as Sri Lanka where conscription into the military and child prostitution are greater problems (de Silva 2001). In addition, in the United States only 3 percent of child maltreatment occurs at day care facilities or other institutions (Prevent Child Abuse America 1997). This rate may be higher in countries such as Romania (Muntean and Roth 2001) and Russia where institutional abuse of children has been identified as a serious problem (Berrien, Safonova, and Tsimbal 2001).

In general, there are a number of individual perpetrator differences that predict abuse in the West. For instance, individuals who were abused as children are believed to be more at risk to become abusers as adults (Straus, Gelles, and Steinmetz 1980). Physical abuse is also more likely to occur in family situations in which parental knowledge of parenting skills is inadequate, when high levels of stress are present, when parents are very young, when parental expectations are too high regarding a child's behaviors, when substance abuse is present, and/or when adults in the family have low levels of empathy towards a child (Kolko 1996). Abuse is found more often in families with female children (Sedlack and Broadhurst 1996) and in families with four or more children ( Juvenile Justice Bulletin 1999). Finally factors such as economic distress, lack of social support, and cultural or religious values have been linked to incidences of physical abuse in most countries that have addressed this problem (Schwartz-Kenney, McCauley, and Epstein 2001).

Effects of Abuse and Neglect: Long-Term and Short-Term Effects

There is little cross-cultural data on differences in harm to victims of child neglect and abuse in different countries. However, when one looks at studies from different countries there are a number of similarities. In general, empirical studies indicate that various forms of child maltreatment negatively affect the victim's development physically, intellectually, and psychosocially (Kempe and Kempe 1978; Mullen et al. 1993). Child victims of neglect and/or abuse are 1.75 times more likely to experience posttraumatic stress disorder as adults compared to individuals who did not experience neglect and/or abuse (Widom 1999). In addition, child victims are more likely to experience depression, attachment difficulties, and low self-esteem (Kolko 1996). A Canadian study found that a history of child abuse was one of the leading predictors of psychological problems in adulthood (Mian, Bala, and MacMillan 2001). Many studies also indicate the long-term effects of maltreatment given the carry-over from one generation to the next (Zuravin et al. 1996).

Furthermore, there are particular risks and harm associated with certain types of abuse, which are more prevalent in certain countries. For example, in addition to the negative outcomes discussed above, conscription into the military carries with it the risk of physical injury or death. Being forced to work as a prostitute significantly increases the chance of becoming infected with HIV or other sexually transmitted diseases. In India, which has a very high rate of child labor, children are often forced to work in dangerous conditions at exhausting hours (Segal 2001).

Finally, in addition to the harm of neglect and abuse to the individual child, there is also a broader harm or cost to society as a whole. Researchers have established a link between experiencing neglect and abuse as a child and engaging in illegal and delinquent behaviors as a teenager and adult (Widom 2001).

Cultural Differences

One must take into account the vast cross-cultural differences that exist when defining any type of child maltreatment. By examining comparative data from a diverse group of cultures, perhaps cultural factors and social structures can be identified to help us gain a better understanding of factors that contribute to abuse and factors that might assist in effectively preventing abuse. Simple definitions of child abuse and neglect do not exist, although there are a number of similarities in definitions even across cultures. Regardless of the differences in how abuse is defined, the number of reports of abuse has risen dramatically in the last decade without the needed growth in staff to respond to this increase in reports. This clearly indicates the need for greater prevention, resources dedicated to staffing, and effective treatment of this worldwide social problem.

PSYCHOLOGICAL MALTREATMENT

Children should be protected against all forms of child maltreatment, including physical or mental violence, injury, abuse, or neglect. Children who have been maltreated should be given all necessary support to achieve recovery. These principles now have nearly universal acceptance by virtue of the standards of Articles 3, 19, 34, and 39 of the United Nations Convention on the Rights of the Child (United Nations General Assembly 1989), a treaty ratified by 191 of the 193 recognized nations of the world.

There are two major types of child maltreatment: physical and psychological. Sexual abuse, generally a combination of the two major types, is primarily psychological in the nature of its acts and consequences. Psychological maltreatment is understood to occur alone as psychological abuse or
neglect, to occur in association with other forms of abuse and neglect, and to be the embedded psychological context and meanings of other forms of abuse and neglect.

The present empirical and theoretical knowledge base for child maltreatment supports the view considering psychological maltreatment to be the unifying concept embodying many of the most significant components of child abuse and neglect (Binggeli, Hart, and Brassard 2001). Essential aspects of this knowledge base are presented in this entry.

Definition

The lack of an adequate definition of psychological maltreatment was a major obstacle to making progress dealing with the issue during the first decades of serious societal consideration of child maltreatment (1960–1990). Since the early 1980s recognizable advances have been made in articulating rationally defensible definitions of psychological maltreatment that have substantial professional and public support.

The first U.S. law on child abuse—Public Law 93–247, originally passed in 1974—included attention to psychological maltreatment under the category of "mental injury." Early attempts to elaborate this ambiguous category in national policy and state law were not adequate and resulted in a confusing diversity of terms and standards. Significant progress toward a useful definition occurred through the processes and outcomes of the International Conference on Psychological Abuse of the Child (Office for the Study of the Psychological Rights of the Child 1983); through conceptual and empirical research (Baily and Baily 1986; Brassard, Germain, and Hart 1987; Garbarino, Guttman, and Seely 1986; Hart and Brassard 1989–1991); and through the development of related standards by the American Professional Society on the Abuse of Children (APSAC) (1995). Concern about psychological maltreatment internationally is displayed in the laws of Sweden prohibiting emotional psychological abuse of children, and in the expansion of child protection law in Singapore to include "emotional injury" in the definition of when a child or young person needs care and protection (Children and Young Persons [Amendment] Act 2001; source: Ministry for Community Development and Sports, Singapore).

The term psychological maltreatment has come to be preferred to other labels (e.g., emotional abuse and neglect, mental abuse or injury). It includes both the cognitive and affective (psychological) meanings of maltreatment as well as perpetrator maltreatment acts of both commission and omission.

The strongest expert-supported definition of psychological maltreatment is presently in the APSAC Guidelines for Psychosocial Evaluation of Suspected Psychological Maltreatment of Children and Adolescents (1995). These guidelines include the following conceptual statement and psychological maltreatment categories:

Psychological maltreatment means a repeated pattern of caregiver behavior or extreme incident(s) that convey to children that they are worthless, flawed, unloved, unwanted, endangered, or only of value in meeting another's needs (p. 2).

Psychological maltreatment includes: (1) spurning (i.e., hostile rejecting/degrading verbal and nonverbal caregiver acts that reject and degrade a child); (2) terrorizing (i.e., caregiver behavior that threatens or is likely to physically hurt, kill, abandon, or place the child or child's loved ones or objects in recognizably dangerous situations); (3) isolating (i.e., caregiver acts that consistently deny the child opportunities to meet needs for interacting or communicating with peers or adults inside or outside the home); (4) exploiting/corrupting (i.e., modeling, permitting, or encouraging antisocial behavior); (5) denying emotional responsiveness (i.e., caregiver acts that ignore the child's attempts and needs to interact and show no emotion in interactions with the child); and (6) mental health, medical, and educational neglect (i.e., ignoring the need for, failing, or refusing to allow or provide treatment for serious emotional/behavioral, physical health, or educational problems or needs of the child).

These six categories of psychological maltreatment are further delineated through detailed subcategories that clarify their meanings (APSAC 1995). Empirical and conceptual support for these categories and definitions will be found in child-study research (Rohner and Rohner 1980; Claussen and Crittenden 1991; Egeland and Erickson 1987; Binggeli, Hart, and Brassard 2001); and in expert- and public-opinion research (Burnett 1993; Portwood 1999).

Incidence and Prevalence

Incidence of maltreatment generally refers to the number of new cases coming to the attention of authorities within a given year. Prevalence represents the total number of people in a sample who have ever experienced the maltreatment.

The true incidence of psychological maltreatment is unknown. The best available estimates of the incidence of psychological maltreatment come from findings of the National Incidence Study and research on verbal aggression. The National Incidence Study of the Federal Office on Child Abuse and Neglect (Sedlak and Broadhurst 1996) applies both an existing Harm Standard and a projected Endangerment Standard in gathering data from local social service, health and law enforcement professionals, and child welfare agencies. Data for 1993 supported estimates of more than 1.5 million children abused or neglected under the Harm Standard and three million under the Endangerment Standard, with approximately 532,000 of these children emotionally abused and 585,100 emotionally neglected. High annual levels of verbal/symbolic aggression (defined as "communication intended to cause psychological pain to another person, or a communication perceived as having that intent," [Vissing et al. 1991, p. 224]) were found in a telephone survey of the tactics used by a national sample of 3,458 parents to deal with conflicts in relations with their children. Over 11 percent if the children were reported to have experienced an average of more than two such incidents per month, whereas 63 percent experienced at least one such incident per year (Vissing et al. 1991).

Prevalence estimates can be made from data collected in studies of the childhood-experience histories of adults, retrospectively surveyed, using definitions similar to those in the APSAC Guidelines (1995). Nelson Binggeli, Stuart Hart, and Marla Brassard (2001) concluded, from reviews of such studies, that over one-third of the adult population has had significant psychological maltreatment experiences and that 10 to 15 percent of the adult population has suffered chronic or severe psychological maltreatment. Confidence in these estimates is further supported by the facts that the definitions used in these studies were fairly conservative, the types were considered appropriate by both researchers and community representatives, and it is more likely that the subjects minimized rather than exaggerated their maltreatment histories.

Evidence of Impact

Evidence that psychological maltreatment is a threat and destructive to the well-being and development of children is vital to producing the societal concern and interventions necessary to combat it. Until recently, however, the relationship between psychological maltreatment and negative developmental consequences for victims have had to be accepted as somewhat speculative because the construct was not well defined.

The existence of the broadly supported definitions for spurning, terrorizing, isolating, corrupting/exploiting, and denying emotional responsiveness has made it possible to carry out more rigorous reviews of related research literature. The available knowledge base indicates that psychological maltreatment probably has the most severe, longest lasting, and broadest range of negative developmental consequences of any form of child abuse or neglect (with the exception of the killing of a child), and that it is the core component in child abuse (Hart, Brassard, and Binggeli 1998).

Longitudinal and cross-cultural research has identified psychological maltreatment as a significant contributor to the following conditions: children who become angry, assaultive, or aggressive; delinquent, criminal, and/or substance abusers; persons who feel unloved and inadequate; and persons who develop negative feelings and perspectives about the purposes and possibilities for enjoyment of life, including having a happy marriage and being a good parent (Egeland and Erickson 1987; Rohner and Rohner 1980). Studies comparing the effects of various forms of child maltreatment have documented that (a) combinations of verbal abuse and emotional neglect tend to produce the most powerfully negative outcomes; (b) psychological maltreatment is a better predictor of detrimental developmental outcomes for young children than is the severity of physical injury experienced by children; (c) psychological maltreatment is the indicator most related to behavior problems for children and adolescents, and is more strongly related to physical aggression, delinquency, or interpersonal problems than parental physical aggression; (d) psychological abuse is a stronger predictor than physical abuse of both depression and low self-esteem and, in particular, is strongly related to anxiety, depression, interpersonal sensitivity, dissociation (disruption in usually integrated functions of consciousness, identity, or perception of the environment), and low self-esteem; and (e) psychologically unavailable caretaking is the most devastating of all maltreatment forms (Briere and Runtz 1990; Claussen and Crittenden 1991; Egeland and Erickson 1987; Vissing et al. 1991).

Theoretical Perspectives

Psychological maltreatment is an interpersonal experience. The essential role of interpersonal relations in human development and need fulfillment establishes an inherent vulnerability to psychological maltreatment. Many of the major theories in psychology contain constructs that are related to psychological maltreatment, particularly in the way they describe critical factors of the developmental process susceptible to the influences of various kinds of interpersonal experiences. Human needs theory, psychosocial stage theory, attachment theory, parental acceptance-rejection theory, the coercion model and the prisoner of war model each have value for psychological maltreatment research and interventions. They clarify the ways in which psychological maltreatment interferes with need fulfillment and development processes and produce retardation and/or distortions in growth and behavior (Binggeli, Hart, and Brassard 2001).

Psychological Maltreatment and the Law

In general, psychological maltreatment has not led to coercive or punitive governmental intervention, unless it accompanied other forms of maltreatment. Judicial precedents on psychological maltreatment are, for most part, unavailable to courts because there have been few reported appellate court decisions on stand-alone psychological maltreatment. Child protection officials and judges must largely be guided by the relevant language in state laws. Current state laws indicates that the federal "mental injury" principle has proven difficult for many legislatures to define.

Some states have simply used the term mental injury—or some similar term—without further explanation. Other states have incorporated one or more of the following standards or requirements:

The child has experienced serious psychological or mental injury caused by recognizable acts;

Injuries must be observable, substantial, sustained, and identifiable impairments of the child's intellectual or psychological capacity or emotional stability;

Specific recognition of certain forms of psychological maltreatment (e.g., isolation through use of mechanical devices to physically restrain).

The psychological maltreatment experienced by children due to exposure to domestic violence in the home is an emerging area of concern. Evidence of negative child-impact from observed domestic violence is growing (Hughes and Graham-Bermann 1998). California (Domestic Violence Unit 1999) has taken deliberate efforts to work toward identifying and serving domestic violence–exposed children as abused.

Despite the myriad of potential statutory variations for legal intervention where psychological harm has been inflicted upon children by their parents, it should be possible for judicial and CPS agency efforts to be applied to psychological maltreatment cases. For this to occur, it will require a change from the status quo: child welfare agency personnel, attorneys, and juvenile court judges will need to be educated on psychological maltreatment (Hart et al. 2001).

Interventions for Psychological Maltreatment

Substantial progress has been made in guiding assessments in cases of suspected psychological maltreatment of children, whereas only small beginnings have been made in developing effective correction and prevention strategies. The APSAC Guidelines (1995) provides the best available framework for professionals in evaluations of suspected psychological maltreatment. The guidelines were designed to assist in case planning, legal decision making, and treatment planning for psychological maltreatment that occurs as a powerful single instance or continual pattern, and maltreatment that occurs in isolation from as well as in conjunction with other forms of abuse and neglect. The Guidelines assist in making determinations of the nature and severity of psychological maltreatment, including extant or predicted developmental impact, through direct observation, interviews, review of records and collateral reports, and consultation. The Guidelines also help professionals apply ethical standards, weigh cultural factors, and report findings.

In general, the development of effective strategies for prevention and treatment of child maltreatment has been elusive, and psychological maltreatment has received relatively little direct attention in this regard. Intervention models applied to perpetrators and families that have shown improved outcomes have devoted resources (e.g., reduced client load, highly trained and well-supervised therapists, and many client contact hours) well beyond those usually available to child protective services or contracted private agencies. Although the development and study of specific treatments for children has genuine potential, according to existing research findings, it remains uncommon. Available research does indicate that children generally experience greater treatment gains than adults and provides unquestionable evidence of intergenerational transmission of child maltreatment.

It appears wise to give prevention the top intervention priority for child maltreatment, and particularly for psychological maltreatment because it is such a pervading, insidious, and powerfully destructive force. Studies of resilience have identified affiliation and self-efficacy (i.e., realistic confidence in one's competence to deal effectively with life's challenges and opportunities) as necessary to support healthy development under difficult conditions. Prevention and correction are well served by programs supporting development of secure attachment to adult caretakers through sensitive, responsive parenting and pre-school and elementary school teacher-student relations; through modeling and promoting appropriate childcare and interpersonal skills for parents and children; and through helping children develop a genuine sense of practical competence in school and community play and work, including problem solving and conflict resolution. Progress can be made if high quality intervention research and effective programs are supported through societal commitment and funding.

hart, s. n., and brassard, m. r. (1989–1991). final report(stages 1 and 2). developing and validating operationally defined measures of emotional maltreatment: a multimodal study of the relationship between caretaker behaviors and children characteristics across three developmental levels (grant no. dhhs90ca1216). washington, dc: department of health and human services and national center for child abuse and neglect.

office for the study of the psychological rights of thechild (1983). proceedings summary of the international conference on psychological abuse of children and youth (indiana university purdue university indianapolis). indianapolis: author, indiana university.

SEXUAL ABUSE

Each year, thousands of boys and girls are sexually abused. The effects of this abuse can last a lifetime. The American Academy of Pediatrics (1991) defines sexual abuse as "engaging of a child in sexual activities that the child cannot comprehend, for which the child is developmentally unprepared and cannot give informed consent, and/or that violate the social and legal taboos of society" (p. 254).

Sexual abuse accounts for 12 percent of the one million substantiated cases of child abuse and neglect annually (Reece 2000). Approximately 20 percent of adult women, and 5 to 10 percent of men have been sexually abused as children. The peak age of vulnerability to sexual abuse is between seven and thirteen years of age, but children older or much younger have been abused (Finkelhor 1994). Girls are approximately three times more likely to be sexually abused than boys (Sedlak and Broadhurst 1996). The overwhelming majority of victims know their abusers. Girls are more likely to be abused by family members, and boys by friends of the family (Kendall-Tackett and Simon 1992).

The Effects of Sexual Abuse

The effects of sexual abuse are its most highly studied aspect—and its most political. Some claim sexual abuse is always harmful. Others maintain that some children actually benefit from these sexual experiences. And some children show no symptoms at all (Kendall-Tackett, Williams, and Finkelhor 1993). Allegations of abuse also raise legal and custody issues.

Short-term effects. Children experience a wide range of symptoms after they have been sexually abused. Some symptoms show up immediately, and others appear as delayed responses. Still others get better over time. Traumatic events, including sexual abuse, can alter the brains of children, and the effects may not be obvious for several years (Perry 2001).

Posttraumatic stress disorder (PTSD) is common, but not specific to sexual abuse. Sexualized behavior is the most characteristic symptom, but not one that every child manifests. It is also one of the more disturbing symptoms and includes public masturbation, sexual play with dolls, and asking other children and adults to participate in sexual activity.

Symptoms by age of child. The symptoms that children manifest also vary by age of the child. For example, preschool-age children are more likely to experience anxiety, nightmares, or sexual acting out. Common symptoms for school-age children include fear, aggression, school problems, hyperactivity, and regressive behaviors. Adolescents are more likely to be depressed, attempt suicide, abuse substances, or participate in illegal behaviors. Symptoms often change over time. For example, a preschooler who is sexually acting out may become an adolescent with multiple sexual partners (Kendall-Tackett et al. 1993).

Long-term effects. The effects of child sexual abuse can continue well into adulthood. Symptoms adult survivors manifest are often logical extensions of dysfunctional coping mechanisms developed during childhood. While these dysfunctional behaviors may have helped the child cope with on-going abuse, they have a negative impact on adult functioning. Long-term effects can be divided into seven categories (Briere and Elliot 1994; Kendall-Tackett and Marshall 1998):

Posttraumatic stress disorder (PTSD). Post-traumatic stress disorder (PTSD) is a commonly occurring symptom among adult survivors of sexual abuse. According to John Briere and Diana Elliot (1994), 80 percent of abuse survivors have symptoms of PTSD, even if they do not meet the full diagnostic criteria. These reactions include hypervigilance, sleep disturbances, startle responses, intrusive thoughts, and flashbacks.

Cognitive distortions. Sexual abuse survivors often learn to perceive the world as a dangerous place. These cognitive distortions make them more vulnerable to both re-victimization and depression because they believe they are powerless to change their lives.

Emotional distress. Emotional distress is another common symptom among adult survivors. Sexual abuse survivors have a lifetime risk of depression that is four times higher than their nonabused counterparts. They may also experience mild-to-severe anxiety and anger on a regular basis.

Impaired sense of self. Survivors may have difficulty separating their moods and emotional states from the reactions of others. If their partners are depressed or angry, survivors are too, without necessarily considering whether they really feel the same way. Impaired sense of self can also inhibit self-protection, increasing survivors' risk of re-victimization.

Avoidance. Avoidance includes some of the more serious sequelae of past abuse. Survivors may experience dissociation, which includes feeling separated from their bodies, emotional numbing, amnesia for painful memories, and multiple personality disorder. Other types of avoidant behavior are substance abuse, suicidal ideation and attempts, and tension-reducing activities, including indiscriminate sexual behavior, bingeing and purging, and self-mutilation.

Interpersonal difficulties. Adult survivors may have problems with interpersonal relationships. They may adopt an avoidant style, characterized by low interdependency, self-disclosure, and warmth. Or they may adopt an "intrusive" style, characterized by extremely high needs for closeness, excessive self-disclosure, and a demanding and controlling style. Both styles result in loneliness (Becker-Lausen and Mallon-Kraft 1997).

Physical health problems. Adult survivors have substantially higher rates of health care use than their nonabused counterparts. Pain syndromes are the most common type of illness and include irritable bowel syndrome, fibromyalgia, headache, pelvic pain, and back pain. Adult survivors also had overall lower satisfaction with their physical health than their nonabused counterparts (Kendall-Tackett 2000).

Differences in Response to Sexual Abuse

Reactions to child sexual abuse can vary tremendously depending on the child, the family, whether it was reported to law enforcement, and the types of support that were available after disclosure. Responses can also vary by both characteristics of the abuse and ethnicity of the child.

Characteristics of the abuse. Characteristics of the abuse itself can also exert an influence on how people react. Some people are more seriously affected by abuse because their experiences were more severe. In general, abuse will be more harmful if the abuser is someone the child knows and trusts, and the abuse violates that trust. Abuse that includes penetration (oral, vaginal, or anal) often leads to more symptoms. Abuse that occurs often and lasts for years will typically be more harmful than abuse that happens only sporadically and over less time. The exception is the one-time violent assault (Berliner and Elliot 1996; Kendall-Tackett et al. 1993).

Differences among ethnic groups. Researchers have identified some specific ethnic-group differences in both characteristics of abuse and in reactions to it. Although no clear patterns have emerged, there are enough differences for professionals to understand the importance of ethnic group identity and meaning of sexual abuse in a culture.

Asian children tend to be older at the onset of victimization than non-Asians. African-American children tend to be younger at onset than either their Asian or Caucasian counterparts (Berliner and Elliot 1996). African-American victims have approximately the same rates of victimization as Caucasian children, but are more likely to experience penetration as part of their victimization experience (Wyatt 1985). The overall rates of sexual abuse are lowest for Asian women, but high for Hispanic women, when reported retrospectively (Russell 1984). In a sample of 582 Southwestern American Indians, rates of sexual abuse were high, especially among females. Forty-nine percent of females in the sample and 14 percent of males reported a history of sexual abuse. Seventy-eight percent reported intrafamilial abuse (Robin et al. 1997). Worldwide, rates of child sexual abuse have similar ranges (from low to high). According to the World Health Organization (1999), in studies from nineteen countries, including South Africa, Sweden, and the Dominican Republic, rates of sexual abuse range from 7 percent to 34 percent for girls, and from 3 percent to 29 percent for boys. Some of these differences in range are due to varying definitions of sexual abuse from country to country and the accuracy of the reporting system.

Culture and ethnicity also appear related to how symptomatic abuse survivors become in the wake of their abuse experiences. Ferol Mennen (1995) found that Latina girls whose abuse included penetration were more anxious and depressed than African-American or white girls who experienced penetration. The author explains these findings in part as due to the emphasis on purity and virginity in Latino communities. When virginity is lost, the trauma of sexual abuse is compounded because the Latina girls feel that they are no longer suitable marriage partners.

Another ethnic-group difference appeared in rates of re-victimization. In a sample drawn from a community college, black women who were sexually abused in childhood were more likely to be raped as adults than their white, Latina, or Asian counterparts (Urquiza and Goodlin-Jones 1994).

Gordon Nagayama Hall and Christy Barongan (1997) speculated that these differences in rates of sexual aggression might be due to characteristics of specific cultures. For example, cultures with a collectivist orientation, where the group is more important than the individual, tend to have lower rates of sexual aggression. Asian cultures often have a collectivist orientation. Crimes against a single person are perceived as crimes against the entire culture. Shame also keeps these behaviors in check. However, as Catherine Koverola and Subadra Panchandeswaran (in press) describe, shame may not keep the behaviors in check, but may keep people from acknowledging these crimes outside the community. Thus, it is at least possible that even in cultures where the rates appear low, abuse may simply be hidden from view.

How Sexual Abuse Compares with Other Types of Child Maltreatment

Although researchers have focused predominantly on sexual abuse, it is not the most common type of maltreatment. In the Third National Incidence Study of Child Abuse and Neglect, the rate of sexual abuse per 1,000 children was 4.9 for females and 1.6 for males. For physical abuse the rate was 5.6 per 1,000 for females and 5.8 for males. For neglect, the rate was 12.9 per 1,000 for females and 13.3 for males. Physical abuse and neglect are much more common for both boys and for girls. Girls and boys have approximately the same rates of fatal injuries (.01/1000 and .04/1000 for females and males respectively). Sexual abuse can certainly be harmful, but the plight of the physically abused or neglected child also deserves the attention of professionals (Sedlak and Broadhurst 1996).

Conclusion

Abuse experiences vary in their severity, as do reactions of those who are sexually abused. Even when the experience is severe, however, there is hope for healing. In one study, survivors reported that good came from the tragedy of their abuse (McMillen, Zuravin, and Rideout 1995). They described how their abusive pasts made them more sensitive to the needs of others. Many felt compelled to help others who had suffered similar experiences.

perry, b. d. (2001). "the neuroarcheology of childhoodmaltreatment: the neurodevelopmental costs of adverse childhood events." in the cost of child maltreatment: who pays? we all do, ed. k. franey, r. geffner, and r. falconer. san diego, ca: family violence and sexual assault institute.

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Child Abuse

National Survey of State Laws
COPYRIGHT 2008 Cengage Learning

26. Child Abuse

If child abuse is not the most serious crime facing our society today, it is certainly one of the most heart-wrenching. There are many attempts under way to remedy the underlying causes of child abuse, but, until it is eliminated states have unanimously responded with laws specifically designed to identify and punish child abusers.

Child abuse is an insidious type of crime where the victims are, for many reasons unable to, or are fearful of confronting or reporting the perpetrator to authorities. Therefore, the laws surrounding abusive activity contain an element not found in many other criminal statutes. Under the laws of many states, third parties with knowledge of, and reasonable cause to believe that abuse has occurred, are under a legal obligation to report the situation to the authorities.

The reporting provision is the most controversial and the most problematic of this area of the law. In our society, many relationships are held in particularly high regard and communications in those relationships are given special protection. For example, the law seeks to encourage communication between patient and doctor, client and attorney, and congregant and clergy, and protects the content of any communication between them from discovery by third parties by providing a “privilege,” or a rule, that prohibits the doctor, lawyer or clergy from revealing the content of any communications that take place within that particular professional relationship. There are also certain occasions, not covered by the privilege where parties may presume their relationship to be confidential, such as between parent and teacher. Under the child abuse laws for some of these relationships, the professional in such relationships must now report any known or suspected abusive behavior to the proper authorities.

Virtually every state requires doctors, teachers, day care providers and law enforcement officers to report child abuse, but there is less uniformity among the states with regard to lawyers, clergy, therapists, or counselors. A few states require commercial photographic film processors to report to the proper authorities evidence of abusive activity. Some states are very specific in stating exactly who may be protected by the privilege, but some are noticeably vague. This is because the privilege itself is considered so important that a general abrogation of the privilege may be generally detrimental to the important relationships involved. For example, some states require health care professionals to report incidences of abuse, while others list as many as 20-29 professions, including dentists, chiropractors, nurses, hospital personnel and Christian Science practitioners.

The loss or abuse of privilege is not the only controversial or problematic provision of these laws. In many states, the definitions of what constitutes abuse is so broad as to cover a number of different circumstances, including some that may not be abusive at all. Coupled with the fact that in many states one need only have a reasonable suspicion that abuse has occurred in order to report it to the authorities, the laws have left many people fearful that innocent behavior may be misinterpreted by well-meaning, or worse, ill-meaning, private citizens.

The agency to whom suspected abuse is reported is often a state child protection office that is not hindered by the same constitutional restrictions to which traditional law enforcement agencies are subject. These agencies are sometimes allowed to take custody of children prior to actually proving that abuse has occurred. This is done in order to protect the child in question from potential abuse when the agent believes that there is a strong likelihood that the child will be, or continue to be harmed. Some critics of these laws fear the potential of extreme invasions into relationships between parent and child on the basis of very little evidence. Indeed, there have been cases where significant charges of child abuse have been made against individuals and severe action taken against them, such as children taken away from parents, day care centers closed down, only to have the charges later dismissed as lacking any concrete evidence whatsoever. For these reasons most states have passed laws that impose penalties not only for failure to report suspected abuse, but also for false reporting.

In the last few years state laws have changed in two significant ways. Several more states have added enticing or forcing children into sexually exploitive activity to the definition of child abuse. This represents a new definition of abusive activity distinct from sexual abuse. Obviously this new definition results from increased attention being given to child pornography. Another change is the addition of pre-natal child abuse to the state statutes of South Dakota, Wisconsin and, arguably, Texas. These provisions raise some difficult questions (to the modern mind at least) about the definition of a “child” in the eyes of the law. It is very likely that these laws may find their way into the courts for further definition.

Harm or threatened harm to a child’s health or welfare through nonaccidental physical or mental injury or sexual abuse/ exploitation

All hospitals, clinics, sanitariums, doctors, medical examiners, dentists, chiropractors, nurses, school teachers and officials, pharmacists, law enforcement officers, social workers, day care workers, mental health professionals, members of the clergy unless privileged communication, or anyone else called upon to render aid or medical assistance to any child

When a child is known or suspected to be victim of abuse or neglect

Department of Human Resources

Knowingly fail to report: misdemeanor with up to 6 months jail or $500

Physical injury or neglect, mental injury (injury to emotional well-being or intellectual or psychological capacity of child as evidenced by an observable and substantial impairment on child’s ability to function); sexual abuse/exploitation, maltreatment

Infliction or allowing of physical injury, impairment of bodily function or disfigurement, serious emotional damage diagnosed by a doctor or psychologist, and as evidenced by severe anxiety, depression, withdrawal, or aggressive behavior caused by acts or omissions of individual having care and custody of child

Specific incidents listed in 12-12-503 include abandonment, extreme and repeated cruelty; intentional, negligent, non-justifiable conduct constituting physical, psychological, or sexual abuse; conduct creating threat of death or permanent impairment; intentionally and without justification disciplining a child by striking on the face or with a closed fist or shaking a child

Sexual abuse or exploitation as listed by incident in 11165.1; neglect; willful cruelty or unjustifiable punishment; any physical injury inflicted other than by accidental means

Health practitioner, child visitation monitors, fire fighter, animal control officer, humane society officer, district attorney, school employees, film processors, clergy, social workers, day care workers, police department employees, administrators or employees of public or private youth organizations or day camps

Knows or reasonably suspects or observes child abuse

To a child protective agency (police or sheriff’s department, county probation department, or country welfare department)

Up to 6 months in jail and/or up to $1,000 if supervisor or administrator; up to 1 yr. in jail and/or up to $5000 fine if any mandated reporter willfully fails to report and abuse results in death or great bodily injury

Act or omission where child subject to sexual assault, molestation, exploitation, emotional abuse or prostitution; where child is in need of food, clothing, shelter, medical care or supervision because parent or guardian fails to do so; where child exhibits evidence of skin bruising, bleeding, malnutrition, burns, fractures, etc.; or circumstances indicate a condition that may not be the product of an accidental occurrence or child tests positive at birth for schedule-I controlled substance

Injuries which are at variance with the history given of them or other than by accidental means; malnutrition, sexual abuse, exploitation, deprivation of necessities, emotional maltreatment, cruel punishment

Persons in healing arts (medicine, dentistry, psychologist), social worker, school employee, medical examiner, or any other person

Knows or reasonably suspects child abuse or neglect

Division of Child Protective Services of Dept of Services for Children, Youth, & Their Families

Fined up to $1000 and/or jailed up to 15 days

State

Code Section

What Constitutes Abuse

Mandatory Reporting Required By

Basis of Report of Abuse/ neglect

To Whom Reported

Penalty for Failure to Report or False Reporting

DISTRICT OF COLUMBIA

§4-1301.02, et seq.

The infliction of physical or mental injury upon a child, including excessive corporal punishment, an act of sexual abuse, molestation, exploitation, or injury that results from exposure to drug-related activity; negligent treatment

Physician, psychologist, nurse, law enforcement officer, school teacher/official, social service worker, day care worker, mental health professional (any other person may make report), medical examiner, dentist, chiropractor

Knows or has reasonable cause to believe a child is in immediate danger of being mentally or physically abused or neglected

Acts or omissions that have resulted in harm to child’s physical or psychological health or welfare (or substantial risk of being harmed); specific injuries listed in 350-1

Any licensed, registered professional of the healing arts or any other health-related occupation; school employees; law enforcement employees; child care providers; medical examiners/ coroners; employees of public or private social, medical or mental health services agency, recreational/sports employees

Reason to believe that child abuse or neglect has occurred or may occur in reasonably foreseeable future

Physician, nurse, resident, intern, coroner, school teacher, day care personnel, social worker, or other person

Reason to believe that a child has been abused, neglected or abandoned, or subject to conditions or circumstances which would reasonably result in abuse, abandonment, or neglect

Department of Health and Welfare or law enforcement agency

Misdemeanor; if reported in bad faith, person guilty of a misdemeanor and liable for actual damages or statutory damages of $500, whichever is greater, plus attorney’s fees; if acting with malice or oppression, court can award treble actual damages or treble statutory damages, whichever is greater

Inflicting or causing, allowing, or creating a substantial risk of physical injury, other than by accident, that causes death, disfigurement, impairment of physical or emotional health, or loss or impairment of any bodily function; committing or allowing to be committed any sex offense; torture, excessive corporal punishment, female genital mutilation; giving child access to controlled substances

Class A misdemeanor; if physician, referred to state medical disciplinary board; if dentist, referred to Dept. of Professional Regulation; false report is offense of disorderly conduct; second offense is Class 4 felony

Any nonaccidental physical injury or mental injury to child’s intellectual or psychological capacity as evidenced by substantial and observable impairment in child’s ability to function within normal range; commission of sexual offense; an illegal drug present in child’s body; cohabitation with person on sex offender registry; manufacture of meth or possession of meth ingredients in presence of child; bestiality in presence of child; allowing prostitution; failure in care of child to provide food, shelter, or clothing necessary for child’s health and welfare

Infliction of mental, physical, or emotional injury causing deterioration of child including negligent treatment, maltreatment, or exploitation to the extent the child’s health or emotional well-being is endangered; includes sexual abuse

Acts seriously endangering the physical, mental, or emotional health of child, including infliction or allowing infliction or attempted infliction of physical or mental injury; exploitation by overwork; sexual abuse or involvement in pornography

Any health practitioner, mental health/social service practitioner, teacher or child care provider, police officer or law enforcement, and commercial film and photographic print processor, and mediators, clergy

Cause to believe that a child’s physical or mental health or welfare is endangered as a result of abuse or neglect

Local child protection unit of the Department of Social Services

Knowingly and willfully fails to report or makes a false report: misdemeanor and up to $500 and/or 6 months jail

Reasonable cause to suspect child abuse or neglect (pregnancy under 12 or venereal disease in child over 1 month but under 12 years is reasonable cause to suspect abuse)

State Family Independence Agency

Civilly liable for proximately caused damages; guilty of misdemeanor punishable by 93 days in jail and/ or fine of not more than $500; intentionally making false report: if abuse was misdemeanor or not a crime, misdemeanor (93 days in jail and/or fine of not more than $100); if abuse is felony, lesser of penalty for the abuse or imprisonment for not more than 4 yrs. and/ or fine of not more than $2,000

Physical or mental injury inflicted on child other than by accidental means or which can’t be reasonably explained; any aversive or deprivation procedures; sexual abuse, neglect-failure to protect a child from conditions which endanger the child’s health; discipline which is not reasonable

Professional and professional’s delegate in healing arts, social services, hospital administration, psychological treatment, child care, education, law enforcement, clergy (for information received while engaged in ministerial duties), any other person may report

Knows or has reason to believe a child is being neglected or physically or sexually abused (or has been in preceding 3 years)

Local welfare agency, police department, county sheriff, or agency responsible for investigating the report

Harm or substantial risk of harm to child’s health and welfare; or abandonment including acts or omissions of person responsible for child’s welfare. Does not include self-defense, defense of others, or action taken to prevent self-harm of child.

Knowingly, intentionally or negligently causing or permitting a child to be: placed in a situation endangering life or physical or mental health, cruelly confined or punished, deprived of necessaries, child under 6 years left unattended in vehicle, or sexually abused or exploited

Physician, medical institution, nurse, school employee, social worker, or other person

Reasonable cause to believe that a child has been subjected to abuse or neglect or observes child being subjected to conditions and circumstances which would reasonably result in abuse or neglect

Department of Health and Human Services or law enforcement agency (also a state-wide toll-free number)

Physical or mental injury of a nonaccidental nature; sexual abuse or exploitation; negligent treatment or maltreatment such that child’s health or welfare is harmed, excessive corporal punishment (432B-150)

Sexual abuse, intentional physical injury, psychological injury such that child exhibits symptoms of emotional problems generally recognized to result from consistent mistreatment or neglect, or physical injury by other than nonaccidental means

Physical injury by other than accidental means; causing substantial risk of death or serious disfigurement or protracted impairment of physical or emotional health; sexual abuse or acts of sexual abuse; willful abandonment; willful isolation of ordinary social contact to indicate emotional or social deprivation; inappropriate placement in institution; neglect by not supplying adequate care, necessaries or supervision

Any person

Having reasonable cause to believe that a child has been subjected to child abuse or acts of child abuse

Division of Youth and Family Services (they also maintain a 24-hour hotline) in Department of Human Services

Reasonable cause to suspect that a child is abused or maltreated or knows from personal knowledge of parent or guardian, facts, conditions, or circumstances which, if correct, would render the child abused or maltreated

Inflicts or allows to be inflicted or creates a substantial risk of injury other than by accidental means or commits, permits, or encourages any type of sexual abuse or creates or allows serious emotional damage to juvenile or does not provide proper care or necessary medical care or abandons child uses inappropriate devices or procedures to modify behavior or encourages, directs, or approves of delinquent acts involving moral turpitude

Any person or institution

Cause to suspect that juvenile is abused, neglected, or dependent, or has died as the result of maltreatment

Director of Department of Social Services in county where juvenile resides

Victim of sexual activity offense constituting abuse or exhibits evidence of physical or mental injury inflicted other than by accidental means, or threats or harm to child’s health and welfare, or is an endangered child under 2919.22

Knows or suspects child has suffered or faces threat of suffering any physical or mental wound, injury, disability, or condition that reasonably indicates abuse or neglect

The Public Children’s Services Agency or municipal or county peace officer in county where child resides

Guilty of making a false report or failure to report religious leader’s abuse by church member or failure to report when child under reporter’s control, supervision: misdemeanor of the first degree. Failure to report: misdemeanor of fourth degree

Harm or threatened harm to child’s health, safety, or welfare including but not limited to nonaccidental physical or mental injury sexual abuse/exploitation or negligent treatment (including lack of provision of necessities such as food, shelter, medical care, etc.) or abandonment

Physician, dentist, nurse, teacher, other person who has reason to believe abuse

Having reason to believe that child is a victim of abuse or neglect

Department of Human Services

Failure to report is a misdemeanor. Any false reporting is reported by Department of Human Services to local law enforcement for criminal investigation and upon conviction, is guilty of misdemeanor and may be fined up to $5,000 plus reasonable attorney’s fees incurred in recovering the sanctions

State

Code Section

What Constitutes Abuse

Mandatory Reporting Required By

Basis of Report of Abuse/ neglect

To Whom Reported

Penalty for Failure to Report or False Reporting

OREGON

419B.005-100

Any assault of a child and any physical injury to a child caused by other than accidental means (including injuries at variance with explanation given for injury), rape, sexual abuse/exploitation, allowing child to engage in prostitution, failure to provide adequate care, buying or selling child as described in ORS 163.537, negligent treatment, threatening harm to child’s health or welfare, any mental injury which includes observable and substantial impairment to child’s ability to function or permitting a child to enter or remain in a place where methamphetamines are being manufactured, exposure to controlled substance that substantially risks child’s health or safety

Any public or private official, except no requirement for psychiatrist, psychologist, clergy, attorney or guardian ad litem to report privileged communication. Attorney not required to report information detrimental to client

Have reasonable cause to believe that child has suffered abuse or has inflicted abuse on child

Child whose death results from or whose physical or mental health or welfare is harmed or threatened with harm including physical or mental injuries sustained as a result of excessive corporal punishment, sexual abuse/ exploitation, neglect or abandonment, encouraging delinquency

Child who is threatened with substantial harm; sustained emotional harm or mental injury (evidenced by observable and substantial impairment of child’s ability to function); subject to sexual abuse/ exploitation; who lacks proper parental care; whose environment is injurious to child’s welfare; who is abandoned, or who has been prenatally subjected to illegal drug or alcohol abuse, or who is knowingly exposed to an environment used to manufacture methamphetamines

Any wound, injury, disability, or physical or mental condition which is of a nature as to reasonably indicate that it has been caused by brutality, abuse, or neglect; also includes sexual abuse

Any person

Having knowledge or being called on to render aid to any child suffering from or sustaining a wound or injury which is of such a nature as to reasonably indicate or which on the basis of available information appears to indicate have been caused by brutality, abuse or neglect

Inflicting or failing to reasonably prevent others from inflicting mental or emotional injury impairing child’s growth, development, or psychological functioning; physical injury resulting in substantial harm, or which is at variance with explanation given; sexual abuse, exploitation, use of controlled substance resulting in mental or physical harm to child

“Professionals,” any person

Having cause to believe that a child’s physical or mental health or welfare has been or may be adversely affected by abuse or neglect

Texas Department of Protective and Regulatory Services or any state or local law enforcement agency, state agency in charge of facility in which abuse occurred or Texas Youth Commission if report based on child’s information. Abuse involving person responsible for child’s care must be reported to Texas Dept of Protective & Regulatory Services

Reason to believe that a child has been subjected to abuse or observe a child being subjected to conditions or circumstances which would reasonably result in abuse or who attends birth or cares for child with fetal alcohol or drug dependency

Nearest peace officer, law enforcement agency, or office of the division

Class B misdemeanor (must be commenced within 4 years from date of knowledge of offense)

Child whose physical health, psychological growth and development or welfare is harmed or is at substantial risk of harm by the acts or omissions of persons responsible for child; includes sexual abuse, abandonment, emotional maltreatment, neglect

Fined up to $500. Failure to report w/intent to conceal: prison up to 6 months and/or fine up to $1000

VIRGINIA

63.2-1501, et seq. ; 63.2-100

To create, inflict or threaten to create or inflict or allow to be created or inflicted upon a child a physical or mental injury by other than accidental means or create a substantial risk of death or impairment; neglect; abandonment; sexual abuse/ exploitation

The injury, sexual abuse/exploitation or negligent treatment of a child, under circumstances which indicate that such child’s health, welfare, or safety is harmed

All practitioners, coroners, law enforcement officer, school personnel, nurse, social services counselor, psychologist, pharmacist, child care providers, juvenile probation officer, health and social services department employee or supervisor in profit or nonprofit organization who reasonably believes supervisee is abusing or any adult who believes a child residing with them has suffered severe abuse or corrections officers whose beliefs are based on observations of offenders with child

Reasonable cause to believe that a child has suffered abuse or neglect

State Department of Social and Health Services or proper law enforcement agency

Physical, mental, or emotional injury, sexual abuse/ exploitation, negligent treatment, sale or attempted sale of child; any circumstances which harm or threaten the health and welfare of the child, domestic violence

Physical injury inflicted on child other than by accidental means, sexual abuse/ exploitation, emotional damage, (harm to child’s psychological or intellectual functioning which is exhibited by anxiety, depression, or other outward behavior) or neglect (failure to provide necessaries of life); on unborn child, habitual lack of self control by expectant mother in use of alcohol and controlled drugs; permitting or encouraging prostitution; manufacturing meth in child’s presence, premises of child’s home, or where meth can be seen, smelled, heard by child

Reasonable cause to suspect that a child has been abused or neglected or has been threatened with abuse or neglect or that abuse or neglect will occur

The county department (or licensed child welfare agency under contract with the county department) or sheriff or police department

Fine up to $1,000 and/or up to 6 months in jail

WYOMING

14-3-201, et seq.

The inflicting or causing of physical or mental injury, harm or imminent danger to the physical or mental health or welfare of a child other than by accidental means including abandonment, excessive/unreasonable corporal punishment, malnutrition, intentional or unintentional neglect or the commission of a sexual offense. Imminent danger includes driving under influence

Any person; member/staff of medical (public or private) institution, school, agency, or facility must also notify person in charge

Reasonable cause to believe or suspect that a child has been abused or neglected or who observes any child being subjected to conditions or circumstances which would reasonably result in abuse or neglect

Child protective agency or local law enforcement agency

Misdemeanor, fine up to $500 and/or up to 6 months in jail for disclosing confidential records of child abuse

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Child Abuse

Encyclopedia of Children and Childhood in History and Society
COPYRIGHT 2004 The Gale Group Inc.

Child Abuse

Child abuse, as a historical subject, is deeply problematic, since the concept of abuse is inevitably relative and can be only very tentatively applied across cultures and across centuries. Parental conduct that would be considered battering abuse in contemporary America might be practiced as routine parental discipline in other parts of the world, and would certainly have been regarded thus in past centuries in America itself. Furthermore, by today's Scandinavian standards even limited corporal punishment, as practiced in some American families, might seem abusive, and there is debate about the acceptability of such punishment within the American medical establishment. Without doubt, judging across cultures, Americans would consider as abusive the female circumcision practiced in parts of the contemporary Islamic world or the foot binding that was once practiced in China. The history and sociology of child abuse thus inevitably involve a recognition of relativism in identifying and describing the practice of abuse, inasmuch as abuse can be best understood within a particular social and cultural context.

Defining Abuse in Historical Context

The watershed in the history of child abuse must be dated as recently as 1962, when child abuse received its modern formulation by the American medical establishment as the battered-child syndrome. The mistreatment of children was certainly common in earlier centuries, indeed timelessly imprinted upon European folklore as recorded, for instance, in the tales of the brothers Grimm. Yet that very prevalence ruled out any consensus about what constituted an abusive divergence from the social norm. The article "The Battered-Child Syndrome," by C. Henry Kempe, Frederic N. Silverman, and colleagues thus marked the end of the ancien régime in the history of child abuse, separating the epochs before and after 1962. Thereafter it was the medical establishment, with its scientific credentials, that defined child abuse according to the evidence of medical examination, including the evidence of radiology, revealing the battered bones of young children. At the same time, the scientific conclusions of "The Battered-Child Syndrome" further implied a set of sociological revelations: first, the general prevalence of abuse in a supposedly enlightened society, and second, the hitherto unacknowledgable circumstance that abuse was not usually the work of evil strangers, or even evil step-parents, but was largely practiced by natural parents upon their own children.

Crucial for the theoretical understanding of the history of child abuse was the history of childhood itself. In 1960 the French historian Philippe AriÈs proposed the controversial theses that the concept of childhood varied and developed in different historical contexts and that modern childhood was, in some sense, "discovered" in the Renaissance; only then, according to Ariès, did European culture and society become fully attuned to the distinctive character of childhood, to its fundamental difference from adulthood. The notion of fundamental difference between childhood and adulthood is essential for understanding child abuse, since the concept of child abuse assumes that there is a distinctive standard for the treatment of children and the violation of that standard defines abuse.

The relevance of the battered-child syndrome for the centuries before 1962 concerns not only the prevalence and intensity of corporal punishment but also the changing norms of punishment that might have made beating seem excessive to contemporaries. Historians such as Lawrence Stone and Philip Greven have described a culture of corporal punishment in early modern England and colonial America that is extreme by modern standards but seemingly normal in the contemporary contexts. Beatings at school constituted routine pedagogical discipline in early modern Europe, England, and the United States, and this continued into modern times, while the punishment of children during the Reformation and Counter-Reformation was prescribed according to differing religious perspectives on the fundamental innocence or sinfulness of children. The well-known principle of not sparing the rod for fear of spoiling the child was not evidence of widespread abuse, but indicated rather that beating was considered an appropriate measure in the rearing of children. In fact, the Protestant culture of corporal punishment still flourished in America in the late twentieth century, prescribed in such fundamentalist publications as God, the Rod, and Your Child's Bod: The Art of Loving Correction for Christian Parents

(1981).

While social practice in early modern families generally involved some degree of corporal punishment and some variation in judging the appropriate degree of intensity, landmark ideological developments in the writings of such philosophers as John Locke and Jean-Jacques Rousseau began to transform the earlier religious controversy concerning children's sinfulness and the application of the rod. Locke, in Some Thoughts Concerning Education (1693), advocated less beating and preferred a penal strategy of inducing shame, while Rousseau, who celebrated the innocence of humanity in the state of nature, was correspondingly convinced of the innocence of children. "Love childhood," he enjoined his readers, in Émile in 1762, outlining a new pedagogy so sensitive to the child's supposed nature that conventional education appeared almost in itself to be something abusive. Rousseau believed that childhood could be violated by inappropriate treatment, and that the child could be accordingly robbed of childhood; such ideas were essential to the formulation of a modern concept of abuse. Stone argues that a whole new culture of child rearing emerged in eighteenth-century England, a culture of coddling, based on indulgence of children and childhood. The controversy surrounding swaddling was characteristic of the century, for Rousseau declared this conventional practice to be cruel and oppressive, in some sense abusive of the child's freedom of the limbs; therefore he called for liberation from swaddling and enlightened parents heeded his appeal.

Locke's preference for shame over corporal punishment eventually pointed the way toward a modern conception of punishment for children in which excessive beating would appear as abusive. Yet considering the twentieth-century French philosopher Michel Foucault's argument on the historical transition from the exemplary punishment of criminals to a social system of discipline and surveillance, one might conclude that children too were subject to the pressures of more comprehensive discipline even when they were ultimately spared the rod. In this sense the crystallization of the concept of child abuse would have occurred at the historical crossroads when beating was no longer regarded as the most efficacious method of pedagogy or discipline.

Innocence and Abuse

The secular standard of children's innocence, dating from the late eighteenth century, suggested whole new arenas for reconsidering what was appropriate treatment of children. The attribution of innocence implied the possibility of violation, and the necessity of protection. The British Parliament passed legislation to protect chimney sweeps in 1788, and in 1789 the poet William Blake conjured their condition in his Songs of Innocence. During the nineteenth century child labor laws were enacted in England, America, France, and Germany, with rhetorical emphasis on the need to protect children from exploitation. That concept of exploitation implicitly suggested the notion of child abuse.

Innocence also implied the need for sexual protection, and beginning in the late eighteenth century, according to the research of historian Georges Vigarello, the prosecution of rape in France began to reflect a new and particular disapproval of the rape of children. Though in the eighteenth century Casanova had sex with girls as young as eleven and cheerfully boasted about it in his memoirs, by the late eighteenth century in Casanova's Venice, sexual relations between adult men and prepubescent girls could also be formulated with emphatic disapproval as the violation of innocence. Nevertheless there was neither a legal nor a sociological framework for identifying such conduct as sexual abuse.

A public breakthrough occurred in the late nineteenth century when the London journalist W. T. Stead exposed the prevalence of child prostitution in the Maiden Tribute scandal of 1885, publishing his revelations, for instance, under the headline, "A Child of Thirteen Bought for Five Pounds." In response to this scandal, the age of sexual consent in England was raised from thirteen to sixteen. Public horror at child prostitution pointed toward the eventual public recognition of sexual abuse, and, in the late nineteenth century, psychiatry further focused on the issue by diagnosing the perpetrators. The nineteenth-century German psychiatrist Richard von Krafft-Ebing, in his Psychopathia Sexualis described the "psycho-sexual perversion, which may at present be named erotic paedophilia (love of children)," which he defined, according to German and Austrian law, as the "violation of individuals under the age of fourteen" (p.371).

The recognition of sexual abuse in its domestic context was almost achieved by Sigmund Freud when he arrived at the "seduction theory" in 1895, ascribing hysteria to the sexual victimization of children by adults, especially their fathers. In 1897 Freud reconsidered this theory, and decided that his patients suffered only from fantasies of sexual violation as children. This conclusion suggests how difficult it was for even the most intellectually adventurous Victorians to confront the concept of child abuse as a common sociological syndrome. In 1919, when Freud wrote the article "A Child is Being Beaten," he discussed this scenario entirely as a matter of fantasy.

Yet in the late nineteenth century, there were established philanthropic societies for intervention on behalf of children neglected or mistreated by their parents. The model, ironically, was the Society for the Prevention of Cruelty to Animals, founded in America in 1866 and followed afterwards by Societies for the Prevention of Cruelty tohildren in America and England in the 1870s and 1880s. A "Children's Charter" in England, in 1889, attempted to formulate the rights of children. Inevitably, the philanthropic societies became the agents of Victorian middle-class intervention in the family life of the poorer classes, for the mistreatment of children was more readily attributed to the poor.

Throughout the Victorian age, dating from the first serial installments of Charles Dickens's Oliver Twist in 1837, at the very beginning of Victoria's reign, the figure of the menaced and mistreated child became a sentimental totem, and the brutalization of childhood's innocence exercised an almost prurient fascination upon the Victorian public. The preservation of innocence became such an obsession in nineteenth-century society that the consequences were often oppressive to the children themselves, and indeed abusive by the modern standard. The most striking instance was the medical preoccupation, all over Europe, with the prevention of masturbation, as parents were encouraged to employ with their children painful precautions, contraptions, and punishments. In 1855 a French governess, Celestine Doudet, was discovered to be torturing five English sisters, with the approval of their father, in order to prevent them from masturbating. She was tried and imprisoned when one of the children died. Similarly, in Vienna in 1899, sensational cases of battering abuse came before the public only when mistreatment actually brought about the children's deaths.

The crucial technological development that brought about the twentieth-century revolution in the recognition of battering abuse was the X ray. Radiology played a pioneering role in exploring the hidden presence of abuse in American families, beginning in 1946 with an article by John Caffey entitled "Multiple Fractures in the Long Bones of Infants Suffering from Chronic Subdural Hematoma." With such crucial discoveries being made in the medical profession, it was, eventually, in the field of pediatrics that the evidence of radiology was synthesized and assimilated, culminating in the publication of "The Battered-Child Syndrome" in 1962. Recognition of the prevalence of a child abuse was a challenge both for the medical profession and for society at large. The authors of "The Battered-Child Syndrome" remarked, "There is reluctance on the part of many physicians to accept the radiologic signs as indications of repetitive trauma and possible abuse. This reluctance stems from the emotional unwillingness of the physician to consider abuse as the cause of the child's difficulty" (pp. 18–19). Yet, by the end of the decade, child abuse laws were adopted in all fifty states, and departments of social services all over America were receiving reports and making interventions in domestic scenarios for the protection of children. In the 1970s the national incidence of child abuse was estimated at 500 cases annually for every million Americans. In 1977 an International Society for the Prevention of Child Abuse and Neglect was established, with backing from the United Nations Children's Fund (UNICEF) and the World Health Organization, for promoting and coordinating awareness of these issues all over the world.

Preventing and Prosecuting Child Abuse

Recognizing the problem has not led to automatic or simple solutions. The most emphatic interventions–that is, the removal of children from the parents' home and sometimes even the complete termination of parental rights–may have disastrous consequences for the child. Depriving the child of parents, even violent and abusive parents, can only be vindicated by the provision of compassionate foster care, which is always, inevitably, in short supply. Indeed, institutional foster care sometimes exposes abused children to new forms of abuse. In December 2002 the New York Times interviewed an adult who had been victimized as a child: "He spent six months with his mother, months when he was abused and beaten again, he said, before being sent to another foster home…. He said he was sexually and physically abused inseveral foster homes."

Even the mandated reporting of suspected abuse has turned out to be an unreliable instrument. Especially the category of neglect, which, according to one pediatric account, encompasses "lack of supervision" and "chaotic life styles," encourges social workers to make rather subjective judgments, especially concerning poor families (Cantwell, p.183). Child abuse in the middle classes, however, remains more easily concealed and less readily suspected. In 1987, New York City, and most of America, was rocked by the sensational coverage of the savage abuse, resulting in death, of Lisa Steinberg, age seven, the daughter of Joel Steinberg, a lawyer, and Hedda Nussbaum, an editor.

Because some of the categories of abuse are inevitably vague, and because American consciousness of abuse changed so rapidly in the course of a generation, it became more and more common in the 1980s for adults to define themselves as victims of abuse in their own childhoods. The category of emotional abuse was considered alongside physical abuse, and some spankings, in memory, seemed like batterings. Furthermore some therapists encouraged their patients to "recover" memories of abuse that had been forgotten or repressed. This was often sexual abuse, sometimes satanic sexual abuse, and in some therapy practices it turned out, implausibly, that 100 percent of patients had been victims of childhood abuse. Issues of sexual abuse also led to devastating legal tangles in the great day care scandals of the 1980s, at the McMartin Preschool in California and the Fells Acre Day Care Center in Massachusetts. At first these cases seemed to suggest hitherto unsuspected depths of child abuse hidden away in the world of institutional day care, but the questionable legal procedure surrounding the children's testimonies led to doubts about their reliability, resulting in mistrials and overturned convictions.

Following the rape and murder of seven-year-old Megan Kanka in New Jersey in 1994, and the subsequent revelation that the crime had been committed by a man who had previously been convicted, a national movement emerged to establish a registry of sex offenders. The determination to identify convicted sexual criminals in local communities, culminating in the passage of "Megan's Law" in New Jersey in 1996, reflected the anxiety in American society about child abuse. Though the abused child can sometimes be identified through bruises or burns by a doctor or a teacher, the abusive adult can rarely be distinguished from others in the community.

A full generation after "The Battered-Child Syndrome" was first published, there is general public recognition that various forms of child abuse are pervasive–but also an awareness that abuse may remain largely concealed within the domestic walls that protect family privacy. Furthermore, just as treatment of children in the historical past may appear abusive by current standards, so there is also a divergence of perspectives within contemporary society about what exactly constitutes abuse. For all these reasons, child abuse is a social problem that has been recognized but by no means resolved. This was emphatically demonstrated at the very beginning of the twenty-first century with the scandalous revelations ofa pedophile predation by Catholic priests in American parishes during the previous several decades. It was discovered that the church hierarchy had been willfully looking the other way, suppressing the scandal of abuse and reassigning pedophile priests who simply continued their abusive conduct in new communities. Public outrage, which eventually resulted in the resignation in December 2002 of Cardinal Bernard Law, the archbishop of Boston, marked a new level of American commitment to the prosecution of child abuse as an unmitigated social evil.

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Child Abuse

Child abuse

Definition

Child abuse is the blanket term for four types of child mistreatment: physical abuse, sexual abuse, emotional abuse, and neglect.

Description

Prevalence of abuse

Child abuse was once viewed as a minor social problem affecting only a handful of U.S. children. However, in the late 1990s and early 2000s it has received close attention from the media, law enforcement, and the helping professions, and with increased public and professional awareness has come a sharp rise in the number of reported cases. Because abuse is often hidden from view and its victims too young or fearful to speak out, however, experts suggest that its true prevalence is possibly much greater than the official data indicate. An estimated 896,000 children across the country were victims of abuse or neglect in 2002, according to national data released by the U.S. Department of Health and Human Services (HHS) in April 2004. Parents were the abusers in 77 percent of the confirmed cases, other relatives in 11 percent. Sexual abuse was more likely to be committed by males, whereas females were responsible for the majority of neglect cases. The data show that child protective service agencies received about 2,600,000 reports of possible maltreatment in 2002. About 1,400 children died of abuse or neglect, a rate of 1.98 children per 100,000 children in the population. In many cases children are the victims of more than one type of abuse. The abusers can be parents or other family members, caretakers such as teachers and babysitters , acquaintances (including other children), and (in rare instances) strangers.

Although experts are quick to point out that abuse occurs among all social, ethnic, and income groups, reported cases usually involve poor families with little education. Young mothers, single-parent families , and parental alcohol or drug abuse are also common in reported cases. Statistics show that more than 90 percent of abusing parents have neither psychotic nor criminal personalities. Rather they tend to be lonely, unhappy, angry, young, and single parents who do not plan their pregnancies, have little or no knowledge of child development, and have unrealistic expectations for child behavior. From 10 percent to perhaps as many as 40 percent of abusive parents were themselves physically abused as children, but most abused children do not grow up to be abusive parents.

Types of abuse

PHYSICAL ABUSE Physical abuse is the non-accidental infliction of physical injury to a child. The abuser is usually a family member or other caretaker and is more likely to be male. One fourth of the confirmed cases of child abuse in the United States involve physical abuse. A rare form of physical abuse is Munchausen syndrome by proxy, in which a caretaker (most often the mother) seeks attention by making the child sick or appear to be sick.

EMOTIONAL ABUSE Emotional abuse is the rejecting, ignoring, criticizing, isolating, or terrorizing of children, all of which have the effect of eroding their self-esteem . Emotional abuse usually expresses itself in verbal attacks involving rejection, scapegoating, belittlement, and so forth. Because it often accompanies other types of abuse and is difficult to prove, it is rarely reported and accounts for only about 6 percent of the confirmed cases.

SEXUAL ABUSE Psychologists define child sexual abuse as any activity with a child, before the age of legal consent, that is for the sexual gratification of an adult or a significantly older child. It includes, among other things, sexual touching and penetration, persuading a child to expose his or her sexual organs, and allowing a child to view pornography. In most cases the child is related to or knows the abuser, and about one in five abusers are themselves underage. Sexual abuse accounts for 12 to 15 percent of confirmed abuse cases. In multiple surveys, 20 to 25 percent of females and 10 to 15 percent of males report that they were sexually abused by age 18.

NEGLECT Neglect, the failure to satisfy a child's basic needs, can assume many forms. Physical neglect is
the failure (beyond the constraints imposed by poverty) to provide adequate food, clothing, shelter, or supervision. Emotional neglect is the failure to satisfy a child's normal emotional needs, or behavior that damages a child's normal emotional and psychological development (such as permitting drug abuse in the home). Failing to see that a child receives proper schooling or medical care is also considered neglect. Slightly more than half of all reported abuse cases involve neglect.

Infancy and toddlerhood

Infants who are premature, mentally retarded, or have physical handicaps are more likely to provoke abuse from their caregiver than are infants without such problems. Similarly, nonhandicapped infants who are nonrhythmic (that is, have uneven sleep and eating patterns) are more likely to be abused. It appears that the child's tendency to learn slowly, to be less coordinated, or less affectionate—rather than any physical problem—that promotes abuse. Infants, because of their fragility, are more susceptible to injury from physical discipline than older children. Infants are especially susceptible to head injury from shaking or being thrown. A baby can be fatally injured by being thrown even onto a soft mattress. The baby's brain hits the back of the skull if the child is thrown with even mild force and intracranial bleeding can result.

Shaken baby syndrome (SBS) is the leading cause of death in child abuse cases in the United States. The syndrome results from injuries caused by someone vigorously shaking an infant, usually for five to 20 seconds, which causes brain damage. In some cases, the shaking is accompanied by a final impact to the baby's head against a bed, chair, or other surface. Although SBS is occasionally seen in children up to four years of age, the vast majority of incidents occur in infants who are younger than one year; the average age of victims is between three and eight months. Approximately 60 percent of shaken babies are male, and children of families who live at or below the poverty level are at an increased risk for SBS (and any other type of child abuse).

Preschool

Typically, abused children show developmental delays by preschool age. It is unclear whether these delays occur due to cumulative neurological damage or due to inadequate stimulation and uncertainty in the child about the learning environment and the absence of positive parental interactions that would stimulate language and motor processes. These delays, in concert with their parents' higher-than-normal expectations for their children's self-care and self-control abilities, may provoke additional abuse. Abused preschoolers respond to peers and other adults with more aggression and anger than do non-abused children. A coercive cycle frequently develops in which parents and children mutually control one another with threats of negative behavior.

School age

School-aged children who are abused typically have problems academically and have poorer grades and performance on standardized achievement tests. Studies of abused children's intellectual performance find lower scores in both verbal and math and visual-spatial areas. Abused children also tend to be distracted and overactive, making school a very difficult environment for them. With their peers, abused children are often more aggressive and more likely to be socially rejected than nonabused children. Less mature socially, abused children show difficulty in developing trusting relationships with others. The anger that is often instilled in such children is likely to be incorporated into their personality structures. Carrying an extra load of anger makes it difficult for them to control their behavior and increases their risk for resorting to violent action. To control their fears, children who live with violence may repress feelings. This defensive maneuver takes its toll in their immediate lives and can lead to further pathological development. It can interfere with their ability to relate to others in meaningful ways and to feel empathy. Individuals who cannot empathize with others' feelings are less likely to curb their own aggression and more likely to become insensitive to brutality in general.

As adolescents, abused children are more likely to be in contact with the juvenile justice system than nonabused children of comparable family constellation and income level. Many of these children are labeled "ungovernable" for committing offenses such as running away and truancy . A higher proportion of abused than nonabused delinquent youth are also involved in crimes of assault. Follow-up studies on abused children in later adolescence show that in addition to having problems with the law, they are also more likely to be substance abusers or to have emotional disturbances such as depression.

Common problems

Physical abuse

The usual physical abuse scenario involves a parent who loses control and lashes out at a child. The trigger may be normal child behavior such as crying or dirtying a diaper. Unlike nonabusive parents, who may become angry at or upset with their children from time to time
but are genuinely loving, abusive parents tend to harbor deep-rooted negative feelings toward their children. Unexplained or suspicious bruises or other marks on the skin are typical signs of physical abuse, as are burns . Skull and other bone fractures are often seen in young abused children, and in fact, head injuries are the leading cause of death from abuse. Children less than one year old are particularly vulnerable to injury from shaken baby syndrome. Physical abuse also causes a wide variety of behavioral changes in children.

Emotional abuse

Emotional abuse can happen in many settings: at home, at school, on sports teams, and so on. Some of the possible symptoms include loss of self-esteem, sleep disturbances, headaches or stomach aches, school avoidance, and running away from home.

Sexual abuse

The two prerequisites for this form of maltreatment are sexual arousal towards children and the willingness to act on this arousal. Factors that may contribute to this willingness include alcohol or drug abuse, poor impulse control, and a belief that the sexual behaviors are acceptable and not harmful to the child. The chances of abuse are higher if the child is developmentally handicapped or vulnerable in some other way. Genital or anal injuries or abnormalities (including the presence of sexuallytransmitted diseases ) can be signs of sexual abuse, but often there is no physical evidence for a doctor to find. In fact, physical examinations of children in cases of suspected sexual abuse supply grounds for further suspicion only 15 to 20 percent of the time. Anxiety , poor academic performance, and suicidal conduct are some of the behavioral signs of sexual abuse but are also found in children suffering other kinds of stress. Excessive masturbation and other unusually sexualized kinds of behavior are more closely associated with sexual abuse itself.

Neglect

Many cases of neglect occur because the parent experiences strong negative feelings toward the child. At other times, the parent may truly care about the child but lacks the ability or strength to adequately provide for the child's needs because handicapped by depression, drug abuse, mental retardation , or some other problem. Neglected children often do not receive adequate nourishment or emotional and mental stimulation. As a result, their physical, social, emotional, and mental development is hindered. They may, for instance, be underweight, develop language skills less quickly than other children, and seem emotionally needy.

Parental concerns

When children reach age three, parents should begin teaching them about "bad touches" and about confiding in a suitable adult if they are touched or treated in a way that makes them uneasy. Parents also need to exercise
caution in hiring babysitters and other caretakers. Anyone who suspects abuse should immediately report those suspicions to the police or their local child protection services agency, which is usually listed in the blue pages of the telephone book under Rehabilitative Services or Child and Family Services, or in the yellow pages. Round-the-clock crisis counseling for children and adults is offered by the Childhelp USA/IOF Foresters National Child Abuse Hotline. The National Committee to Prevent Child Abuse is an excellent source of information on the many support groups and other organizations that help abused and at-risk children and their families. One of these organizations, National Parents Anonymous, sponsors 2,100 local self-help groups throughout the United States, Canada, and Europe. Telephone numbers for its local groups are listed in the white pages of the telephone book under Parents Anonymous or can be obtained by calling the national headquarters.

When to call the doctor

Physical signs of abuse may include bruises, especially those in different stages of healing, bruises in the shape of an object, such as fingers, a ring, or a belt buckle; unexplained burns, black eyes, or broken bones; vaginal or rectal bleeding, pain, itching , swelling or discharge; a vacant stare or dazed appearance; frequent attempts to run away; and sexual promiscuity.

Behavioral signs of child abuse include: low self esteem; flinching or ducking from motion or people moving towards them; eating disorders or loss of appetite; self mutilation such as "cutting," biting oneself or pulling out hair; unusual habits like rocking, sucking cloth; extreme changes in behavioral patterns; poor interpersonal relationships or a lack of self-confidence; clinginess, withdrawal or aggressiveness; regressing to infantile behavior such as bedwetting, thumb sucking or excessive crying; recurrent nightmares , disturbed sleep patterns, or a sudden fear of the dark; unexplained fear of a particular person; unusual knowledge of sexual matters; acting much younger or older than chronological age; frequent lying , or a fall in grades at school; and depression.

It is important to remember that some of these symptoms of child abuse can be normal manifestations of play and activity. Other symptoms could be the result of a traumatic event that is not necessarily abuse, such as divorce . Still, others are definitely "red flag" symptoms of abuse. If any physical signs of abuse appear, get medical help immediately. Talk frankly with the doctor and share any concerns about possible abuse. If there is physical proof of abuse, get a doctor's report in writing. Any behavioral signs of abuse are cause for concern to a good parent, teacher, or caregiver. A good first move is to open and nurture trusting lines of communication. The parent should increase the time spent with the child and increase the attention given to the child. The parent should show more interest in the child's life and ask more questions. The parent needs to assure the child of the parent's unqualified love and support, and make sure the children know that the parent wants them to feel happy and confident. Children need to know that no matter what has happened, their parents will always love them.

KEY TERMS

Munchausen syndrome by proxy—A form of abuse in which a parent induces symptoms of disease in a child.

Nonrhythmic—Having uneven sleep and eating patterns.

Shaken baby syndrome—Injuries caused by someone vigorously shaking an infant, usually for five to twenty seconds, which causes brain damage.

WEB SITES

"Child Maltreatment 2002: Summary of Key Findings." National Clearinghouse on Child Abuse and Neglect Information, April 2004. Available online at <http://nccanch.acf.hhs.gov/pubs/factsheets/canstats.pdf> (accessed November 9, 2004).

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Child Abuse

West's Encyclopedia of American Law
COPYRIGHT 2005 The Gale Group, Inc.

CHILD ABUSE

Physical, sexual, or emotional mistreatment or neglect of a child.

child abuse has been defined as an act, or failure to act, on the part of a parent or caretaker that results in the death, serious physical or emotional harm, sexual abuse, or exploitation of a child, or which places the child in an imminent risk of serious harm (42 U.S.C.A. § 5106g). Child-abuse laws raise difficult legal and political issues, pitting the right of children to be free from harm, on the one hand, against the right of families to privacy and the rights of parents to raise and discipline their children without government interference, on the other.

The mistreatment of children at the hands of parents or caretakers has a long history. For centuries, this behavior was shielded by a system of laws that gave children few, if any, rights. Under English common law, children were treated as property owned by the parents. Parents, particularly fathers, had great latitude over the treatment and discipline of children. This outlook was carried to the American colonies and incorporated into early laws in the United States.

One of the first cases to bring national attention to child abuse arose in the early 1870s. An eight-year-old New York orphan named Mary Ellen Wilson complained of being whipped and beaten nearly every day by her foster family. Her case captured the attention of the American Society for the Prevention of Cruelty to Animals (ASPCA). An attorney for the ASPCA took Wilson's case, arguing that as members of the animal kingdom, children are entitled to the same legal protections from cruelty as are animals. A judge heard evidence that Wilson's foster family, the Connollys, routinely beat her, locked her in a bedroom, and made her sleep on the floor. Charged with assault and battery, Wilson's foster mother was convicted and sentenced to one year of hard labor. Even more significantly, publicity surrounding Wilson's case led to the establishment, in 1874, of the New York Society for the Prevention of Cruelty to Children. The following year, the New York Legislature passed a statute that authorized such societies to file complaints of child abuse with law enforcement agencies.

In 1962, an article in a major medical journal again brought national attention to the issue by identifying the symptoms that can indicate child abuse. The article, by Dr. Henry Kempe, appeared in the Journal of the American Medical Association (JAMA) and discussed a diagnosis for child abuse. The article resulted in widespread awareness of child abuse and prompted further public discussion on ways to address the problem. By 1970, every state had enacted laws requiring certain professionals, such as teachers and doctors, to report incidents of suspected child abuse to law enforcement agencies. In 1974, the Federal Child Abuse Prevention and Treatment Act (42 U.S.C.A. §§ 5105–5106) became law, authorizing federal funding for states to identify child abuse and to offer protective services for abused children.

Statutes make up one component of a state's child-protective services; another component, the child-protective services agency, implements the statutes. Reporting statutes, which vary from state to state, require that certain professionals report suspected child abuse, whereas others, such as neighbors, are entitled but not required to do so. Other statutes define child abuse. For example, in some states, officially recognized physical abuse occurs only when a child suffers a specified type of injury, whereas in other states, any serious injury that is not accidental in nature is considered abuse. Sexual abuse of children generally need not cause injury; any sexual act performed on a child can be considered abuse. Similarly, state statutes categorize as child abuse any neglect of a child that places the child at risk, regardless of whether the child is actually injured. Before substantiating a report of emotional abuse of a child, state statutes generally require a finding of actual harm. Still other statutes specify procedures for investigating child abuse, determining whether a report of abuse is substantiated, intervening to protect an abused child from further harm, and maintaining records of child abuse reports.

When allegations of abuse meet the statutory definitions, the state's child-protective services agency or a law enforcement agency steps in to investigate. Child-protective services agencies generally investigate allegations only when the child's parent or guardian is suspected of causing the abuse or of allowing it to occur. family law presumes that the parent or guardian will protect the child from abuse by other parties and that he or she will contact law enforcement agencies to investigate incidents of abuse by other parties when the parent is not causing or allowing the abuse.

Caseworkers for child-protective services investigate abuse allegations most commonly by interviewing or visiting with the child, the child's parents or guardians, and other sources such as physicians and teachers. If an agent finds evidence that supports a conclusion that the child has been abused, the agency deems the allegations substantiated. The next step is intervention.

Intervention can mean many different things. Frequently, when the risk of further abuse is immediate and significant, child-protective services agents will place the child temporarily in a foster home. Alternatively, agents may monitor the family or may provide counseling in order to curb the threat of abuse. If a family does not cooperate with the intervention efforts of child-protective services, the agency may take the case before a judge, who may determine that abuse or neglect has occurred. He or she may issue a court order mandating the agency's intervention. In extreme cases, agents may remove the child from the home permanently; following a judicial termination of parental rights, the child is then placed for adoption.

Another function of state child-protective services is record keeping, which is accomplished through a system known as the central registry. The central registry contains information about child abuse reports—both substantiated and unsubstantiated—such as the names of the child and of the suspected abuser and the final determination made by the child-protective services worker. This system helps agents in investigating current reports of abuse because it allows them to compare any previous accusations, particularly within the same family. The registry also supplies statistics about child abuse, which help the agency and the state legislature to enact appropriate laws and policies and to provide adequate funding for child-protective services. In some states, other parties may have access to the registry. For example, a day-care center may check the registry before hiring employees, or an adoption agency may check the registry before placing an infant with a family.

Few doubt that state child-protective services agencies provide a valuable service by responding to allegations of child abuse. But such agencies also have their critics. Many people who have been accused of child abuse, particularly parents, object to the way in which these agencies routinely remove children from their homes when child abuse is suspected. Children are traumatized by being taken from their parents, and allegations of abuse are frequently

unfounded, these critics claim. Contentious child custody battles sometimes prompt false accusations of physical or sexual abuse, costing the accused time and money in the fight to reclaim their children and their reputations. Others object to the names of the accused being included on the central registry even when the accusations are unsubstantiated. The backlash against child-protective services spurred the establishment, in 1984, of an information and support group known as Victims of Child Abuse Laws (VOCAL). VOCAL claims to have thousands of members nationwide, and its members lobby for new laws that protect not only children but also parents who are falsely accused of being abusive or negligent.

Despite increased legislation and penalties for child abuse, extreme cases continue to appear and to sustain the debates over child abuse laws. Such cases include the Schoo case in suburban Chicago, which received widespread media coverage. In December 1992, David Schoo, a 45-year-old electrical engineer, and his 35-year-old wife, Sharon Schoo, a homemaker, flew to Acapulco, Mexico, for a Christmas vacation, leaving their daughters, nine-year-old Nicole Schoo and four-year-old Diana Schoo, home alone. The Schoos provided their daughters only with cereal and frozen dinners to eat and a note telling them when to go to bed. One day during their parents' absence, the girls left the house when a smoke alarm sounded. As they stood barefoot in the snow, a neighbor found them, learned of their situation, and called the police.

The Schoos were arrested while still on the plane that returned them from Mexico nine days after they had left their children. Following their indictment on various state charges of child endangerment and cruelty, a grand jury also found evidence that the Schoos had beaten, kicked, and choked their children in order to discipline them. In April 1993, the Schoos plea-bargained, agreeing to serve two years of probation and 30 days of house arrest while the girls remained in foster care. In August 1993, the Schoos agreed to give up their parental rights and placed their daughters up for permanent adoption.

Another nationally publicized case raised questions regarding the effectiveness of child-protective services and implicated social workers charged with protecting the victim. Two-yearold Bradley McGee, of Lakeland, Florida, died in July 1989 from massive head injuries after his stepfather, 23-year-old Thomas E. Coe, repeatedly plunged him head-first into a toilet. Coe later testified that he had become angry when the child had soiled his pants. McGee's 21-year-old mother, Sheryl McGee Coe, pleaded no contest to second-degree murder and aggravated child abuse for allowing her husband to abuse McGee, and received a 30-year prison sentence. Thomas Coe, convicted of first-degree murder and aggravated child abuse, received a sentence of life in prison.

The McGee case alarmed the public not only because of the harsh physical abuse that caused the toddler's death but also because of what many perceived to be a failure in the system that is designed to protect children like Bradley McGee. Two months before his death, Bradley had been living with foster parents owing to allegations of abuse at the hands of the Coes. Despite strong objections by the foster parents, caseworkers for Florida's Health and Rehabilitative Services returned McGee to his mother and stepfather, determining them to be fit parents.

Public reaction was strong following the news of Bradley's death. Four social workers were prosecuted for negligently handling the case, but only the main caseworker, Margaret Barber, was convicted, for disregarding a report from a psychologist who had warned that the Coes were unfit parents. The publicity shed light on problems within Florida's child-protective services agency, including severe understaffing, and led to new laws that emphasize keeping children safe over keeping families together and that also increase funding for more social workers. A Florida appellate court later overturned Barber's felony conviction but left standing a misdemeanor conviction for failing to report child abuse.

In 1997, a controversial court decision led to a new legal concept: abuse of an unborn child. Traditionally, courts have refused to hold a woman who causes injuries to her own fetus criminally liable for the injuries. But in August 1977, the Supreme Court of South Carolina affirmed the criminal conviction of a woman whose crack cocaine usage while pregnant caused the fetus to be born with cocaine in its system, (Whitner v. State, 328 S.C. 1, 492 S.E. 2d 777 [1997]). By regarding the fetus as a person, the 3–2 majority concluded that the mother was guilty of criminal child neglect. In January 2003, the state court revisited its holding in Whitner when it voted 3–2 to uphold the 12-year sentence of a woman who had been convicted under the state's homicide-by-child-abuse law after her cocaine use had resulted in a stillbirth. (State v. McKnight, 353 S.C. 238, 577 S.E. 2d 456 [2003]).

In early 2002, a major child-abuse scandal involving priests shook the Catholic Church. Although child-abuse litigation against priests is hardly new, the public was shocked by the revelation that senior church officials had covered up the facts about widespread abuse. Beginning with allegations against church officials in Massachusetts, the scandal swiftly became national in scope. By year's end, 432 U.S. priests had resigned; at least 1,205 more had been accused of child sex abuse; church officials paid hundreds of millions of dollars to settle victims' lawsuits; and seven grand jury probes continued nationwide.

At the epicenter of the scandal was Boston-based Cardinal Bernard F. Law. Following the molestation conviction of former priest John Geoghan in January 2002, it emerged that Law had known of Geoghan's abuse during the 1980s yet had merely reassigned him to a new parish. More abuse ensued and ultimately led to over $10 million in settlements with victims.

As fresh allegations emerged throughout the year, Law came under bitter public rebuke for allegedly shielding abusive priests from scrutiny, footing their legal bills, and either allowing them to remain on the job or reassigning them to new, unsuspecting parishes. Critics charged that such policies failed to protect children. With church attendance and donations reportedly in decline, the U.S. Conference of Bishops responded by instituting a policy requiring bishops to report abuse allegations to civil authorities. The church also began cleaning house: Following a meeting with the Pope, Law resigned in December 2002.

With most investigations continuing in 2003, grand juries probed possible criminal actions by church officials in Massachusetts, New York, Philadelphia, Phoenix, St. Louis, Los Angeles, and Cincinnati. Even with Law and seven bishops under subpoena, and with evidence of what was called an elaborate cover-up, Massachusetts attorney general Thomas Reilly dampened expectations for a criminal prosecution, due to barriers under state law to holding a superior liable for the actions of a subordinate. In New York, which concluded its probe in February 2003, no charges were brought because the five-year statute of limitations had expired. But grand jurors there issued a blistering 181-page report alleging that church officials had protected 58 sexually abusive priests and that they had intimidated victims in order to prevent legal action. The New York archdiocese denied the allegations.

Legislation at the state and federal levels continues to change to meet the goal of protecting children from abuse and neglect while protecting families from the damage of false accusations.

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Child Abuse

Gale Encyclopedia of Medicine, 3rd ed.
COPYRIGHT 2006 Thomson Gale

Child Abuse

Definition

Child abuse is the blanket term to describe four types of child mistreatment: physical abuse, sexual abuse, emotional abuse, and neglect. In many cases children are the victims of more than one type of abuse. The abusers can be parents or other family members, caretakers such as teachers and babysitters, acquaintances (including other children), and (in rare instances) strangers.

Description

Prevalence of abuse

Child abuse was once viewed as a minor social problem affecting only a handful of United States children. However, it has begun to closer attention from the media, law enforcement, and the helping professions. With increased public and professional awareness has come a sharp rise in the number of reported cases. But because abuse often is hidden from view and its victims too young or fearful to speak out, experts suggest that its true prevalence is possibly much greater than the official data indicate. In 1996, more than three million victims of alleged abuse were reported to child protective services (CPS) agencies in the United States, and the reports were substantiated in more than one million cases. Put another way, 1.5% of the country's children were confirmed victims of abuse in 1996. Parents were the abusers in 77% of the confirmed cases, other relatives in 11%. Sexual abuse was more likely to be committed by males, whereas females were responsible for the majority of neglect cases. More than 1,000 United States children died from abuse in 1996. A 2004 report said that nearly 17% of adult women and 8% of adult men had been abused as children. The United Nations Children's Fund (UNICEF) reported in early 2004 that nearly 3,500 children younger than age 15 die every year from physical abuse and neglect in the 27 richest nations in the world.

Although experts are quick to point out that abuse occurs among all social, ethnic, and income groups, reported cases usually involve poor families with little education. Young mothers, single-parent families, and parental alcohol or drug abuse also are common in reported cases. Charles F. Johnson remarks, "More than 90% of abusing parents have neither psychotic nor criminal personalities. Rather they tend to be lonely, unhappy, angry, young, and single parents who do not plan their pregnancies, have little or no knowledge of child development, and have unrealistic expectations for child behavior." About 10%, or perhaps as many as 40%, of abusive parents were themselves physically abused as children, but most abused children do not grow up to be abusive parents.

Types of abuse

PHYSICAL ABUSE. Physical abuse is the nonaccidental infliction of physical injury to a child. The abuser is usually a family member or other caretaker, and is more likely to be male. In 1996, 24% of the confirmed cases of United States child abuse involved physical abuse.

A rare form of physical abuse is Munchausen syndrome by proxy, in which a caretaker (most often the mother) seeks attention by making the child sick or appear to be sick.

SEXUAL ABUSE. Charles F. Johnson defines child sexual abuse as "any activity with a child, before the age of legal consent, that is for the sexual gratification of an adult or a significantly older child." It includes, among other things, sexual touching and penetration, persuading a child to expose his or her sexual organs, and allowing a child to view pornography. In most cases the child is related to or knows the abuser, and about one in five abusers are themselves underage. Sexual abuse was present in 12% of the confirmed 1996 abuse cases. An estimated 20-25% of females and 10-15% of males report that they were sexually abused by age 18.

The 1990s and early 2000s were rocked by reports of sexual abuse of children committed by Catholic priests. Most of the abuse appeared to have occurred during the 1970s and a prominent report released early in 2004 stated that as many as 10,667 children were sexually abused by more than 4,300 priests. Increases also have been seen in recent years in child pornography cases, where children are the subjects of pornography, particularly on the Internet.

EMOTIONAL ABUSE. Emotional abuse, according to Richard D. Krugman, "has been defined as the rejection, ignoring, criticizing, isolation, or terrorizing of children, all of which have the effect of eroding their self-esteem." Emotional abuse usually expresses itself in verbal attacks involving rejection, scapegoating, belittlement, and so forth. Because it often accompanies other types of abuse and is difficult to prove, it is rarely reported, and accounted for only 6% of the confirmed 1996 cases.

NEGLECT. Neglect—failure to satisfy a child's basic needs—can assume many forms. Physical neglect is the failure (beyond the constraints imposed by poverty) to provide adequate food, clothing, shelter, or supervision. Emotional neglect is the failure to satisfy a child's normal emotional needs, or behavior that damages a child's normal emotional and psychological development (such as permitting drug abuse in the home). Failing to see that a child receives proper schooling or medical care is also considered neglect. In 1996 neglect was the finding in 52% of the confirmed abuse cases.

Causes and symptoms

Physical abuse

The usual physical abuse scenario involves a parent who loses control and lashes out at a child. The trigger may be normal child behavior such as crying or dirtying a diaper. Unlike nonabusive parents, who may become angry at or upset with their children from time to time but are genuinely loving, abusive parents tend to harbor deep-rooted negative feelings toward their children.

Unexplained or suspicious bruises or other marks on the skin are typical signs of physical abuse, as are burns. Skull and other bone fractures are often seen in young abused children, and in fact, head injuries are the leading cause of death from abuse. Children less than one year old are particularly vulnerable to injury from shaking. This is called shaken baby syndrome or shaken impact syndrome. Not surprisingly, physical abuse also causes a wide variety of behavioral changes in children.

Sexual abuse

John M. Leventhal observes, "The two prerequisites for this form of maltreatment include sexual arousal to children and the willingness to act on this arousal. Factors that may contribute to this willingness include alcohol or drug abuse, poor impulse control, and a belief that the sexual behaviors are acceptable and not harmful to the child." The chances of abuse are higher if the child is developmentally handicapped or vulnerable in some other way.

Genital or anal injuries or abnormalities (including the presence of sexually transmitted diseases ) can be signs of sexual abuse, but often there is no physical evidence for a doctor to find. In fact, physical examinations of children in cases of suspected sexual abuse supply grounds for further suspicion only 15-20% of the time. Anxiety, poor academic performance, and suicidal conduct are some of the behavioral signs of sexual abuse, but are also found in children suffering other kinds of stress. Excessive masturbation and other unusually sexualized kinds of behavior are more closely associated with sexual abuse itself.

Emotional abuse

Emotional abuse can happen in many settings: at home, at school, on sports teams, and so on. Some of the possible symptoms include loss of self-esteem, sleep disturbances, headaches or stomach aches, school avoidance, and running away from home.

Child Abuse: Signs And Symptoms

Although these signs do not necessarily indicate that a child has been abused, they may help adults recognize that something is wrong. The possiblity of abuse should be investigated if a child shows a number of these symptoms, or any of them to a marked degree:

Sexual Abuse

Being overly affectionate or knowledgeable in a sexual way inappropriate to the child's age

Medical problems such as chronic itching, pain in the genitals, venereal diseases

Regressing to younger behavior patterns such as thumb sucking or bringing out discarded cuddly toys

Sudden loss of appetite or compulsive eating

Being isolated or withdrawn

Inability to concentrate

Lack of trust or fear someone they know well, such as not wanting to be alone with a babysitter

Starting to wet bed again, day or night/nightmares

Become worried about clothing being removed

Suddenly drawing sexually explicit pictures

Trying to be "ultra-good" or perfect; overreacting to criticism

Physical Abuse

Unexplained recurrent injuries or burns

Improbable excuses or refusal to explain injuries

Wearing clothes to cover injuries, even in hot weather

Refusal to undress for gym

Bald patches

Chronic running away

Fear of medical help or examination

Self-destructive tendencies

Aggression towards others

Fear of physical contact—shrinking back if touched

Admitting that they are punished, but the punishment is excessive (such as a child being beaten every night to "make him/her study")

Fear of suspected abuser being contacted

Emotional Abuse

Physical, mental, and emotional development lags

Sudden speech disorders

Continual self-depreciation ("I'm stupid, ugly, worthless, etc.")

Overreaction to mistakes

Extreme fear of any new situation

Inappropriate response to pain ("I deserve this")

Neurotic behavior (rocking, hair twisting, self-mutilation)

Extremes of passivity or aggression

Neglect

Constant hunger

Poor personal hygiene

No social relationships

Constant tiredness

Poor state of clothing

Compulsive scavenging Emaciation

Untreated medical problems

Destructive tendencies

A child may be subjected to a combination of different kinds of abuse. It is also possible that a child may show no outward signs and hide what is happening from everyone.

Neglect

Many cases of neglect occur because the parent experiences strong negative feelings toward the child. At other times, the parent may truly care about the child, but lack the ability or strength to adequately provide for the child's needs because he or she is handicapped by depression, drug abuse, mental retardation, or some other problem.

Neglected children often do not receive adequate nourishment or emotional and mental stimulation. As a result, their physical, social, emotional, and mental development is hindered. They may, for instance, be underweight, develop language skills less quickly than other children, and seem emotionally needy.

Diagnosis

Doctors and many other professionals who work with children are required by law to report suspected abuse to their state's Child Protective Services (CPS) agency. Abuse investigations often are a group effort involving medical personnel, social workers, police officers, and others. Some hospitals and communities maintain child protection teams that respond to cases of possible abuse. Careful questioning of the parents is crucial, as is interviewing the child (if he or she is capable of being interviewed). The investigators must ensure, however, that their questioning does not further traumatize the child. A physical examination for signs of abuse or neglect is, of course, always necessary, and may include x rays, blood tests, and other procedures.

Treatment

Notification of the appropriate authorities, treatment of the child's injuries, and protecting the child from further harm are the immediate priorities in abuse cases. If the child does not require hospital treatment, protection often involves placing him or her with relatives or in foster care. Once the immediate concerns are dealt with, it becomes essential to determine how the child's long-term medical, psychological, educational, and other needs can best be met, a process that involves evaluating not only the child's needs but also the family's (such as for drug abuse counseling or parental skills training). If the child has brothers or sisters, the authorities must determine whether they have been abused as well. On investigation, signs of physical abuse are discovered in about 20% of the brothers and sisters of abused children.

Prognosis

Child abuse can have lifelong consequences. Research shows that abused children and adolescents are more likely, for instance, to do poorly in school, suffer emotional problems, develop an antisocial personality, become promiscuous, abuse drugs and alcohol, and attempt suicide. As adults they often have trouble establishing intimate relationships. Whether professional treatment is able to moderate the long-term psychological effects of abuse is a question that remains unanswered.

Prevention

Government efforts to prevent abuse include home-visitor programs aimed at high-risk families and school-based efforts to teach children how to respond to attempted sexual abuse. Emotional abuse prevention has been promoted through the media.

When children reach age three, parents should begin teaching them about "bad touches" and about confiding in a suitable adult if they are touched or treated in a way that makes them uneasy. Parents also need to exercise caution in hiring babysitters and other caretakers. Anyone who suspects abuse should immediately report those suspicions to the police or his or her local CPS agency, which will usually be listed in the blue pages of the telephone book under Rehabilitative Services or Child and Family Services, or in the yellow pages. Round-the-clock crisis counseling for children and adults is offered by the Childhelp USA/IOF Foresters National Child Abuse Hotline. The National Committee to Prevent Child Abuse is an excellent source of information on the many support groups and other organizations that help abused and at-risk children and their families. One of these organizations, National Parents Anonymous, sponsors 2,100 local self-help groups throughout the United States, Canada, and Europe. Telephone numbers for its local groups are listed in the white pages of the telephone book under Parents Anonymous or can be obtained by calling the national headquarters.

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Child Abuse

Child abuse

The act of harming children by neglect, physical force, violence, sexual attack, or by inflicting psychological or emotional distress.

For much of history, children were considered the property of parents. The family system was rarely, if ever, intervened upon by society. If a mother or father routinely abused their children, the abuse went unnoticed, or if noticed, merely ignored. It was largely considered a parent's prerogative to do whatever he or she wanted with their child.

Over the past several decades, however, the issue and, seemingly, the prevalence of child abuse have become widespread. Psychologists question whether the number of child abuse cases indicates increased occurrences of abuse or increased public awareness that encourages more reporting.

The first detailed account of the abuse of children was published in 1962 by Harry Hemke in an article titled "The Battered Child Syndrome," and since then there have been numerous articles and books published on this subject.

Over the years, child abuse has been categorized into four types, although many psychologists dispute the usefulness of doing so. In compiling statistics on abuse, the

HOTLINES

The following organizations operate hotlines or provide advice for family members where there are problems related to physical or other abuse.

Childhelp National Abuse HotlineTelephone: toll-free (800) 422-4453

National Coalition Against Domestic ViolenceTelephone: (303) 839-1852

National Council on Child Abuse and Family ViolenceTelephone: toll-free (800) 222-2000

National Victim CenterTelephone: toll-free (800) FYI-CALL [394-2255]

National Runaway SwitchboardTelephone: toll-free (800) 621-4000

United States Department of Health and Human Services (HHS) considers four categories of abuse: neglect, physical abuse, sexual abuse , and emotional maltreatment. Obviously, these categories are not mutually exclusive (that is, any given child can experience one or all, and all types of abuse are forms of "emotional maltreatment").

Statistically, it is difficult to find reliable national figures for cases of child abuse because each state keeps its own records and has its own definitions of what constitutes abuse. Nonetheless, several organizations do compile national estimates of abuse and neglect. One of the most commonly cited reports comes from Prevent Child Abuse America, formerly known as the National Committee for the Prevention of Child Abuse headquartered in Chicago, which conducts an annual national survey of the 50 states to acquire the most current data available.

An estimated 3,154,000 children were reported to child protective service agencies as alleged victims of child abuse or neglect in 1998, with about 1 million of the reports confirmed. This means that 45 children out of 1,000 were reported as abused or neglected and 14 confirmed as abused or neglected in 1998. On average, three children died each day in the United States from abuse or neglect in 1997. While the nation's overall crime rate fell from 1993 to 1997 by 22 percent, reports of child abuse and neglect increased by 8 percent with confirmed cases increasing by 4 percent.

In 1998, 51 percent of the cases reported involved neglect, 25 percent involved physical abuse, 10 percent involved sexual abuse, 3 percent involved emotional abuse and 11 percent related to other forms of child maltreatment. These figures represent substantiated cases, meaning they were investigated by child protection services and found valid. Like any statistics on child abuse, these must be considered incomplete, since not all cases of abuse are reported.

Strong social and familial pressure may continue to exist to avoid the issue when abuse is seen; however, requirements that professionals, such as doctors, teachers, and therapists who work with children, report suspicions of abuse have helped to make public health system intervention more widely accepted by society.

Still, newly arrived immigrants not yet acculturated in the United States may, to their surprise, face social service intervention for their cultural practices toward children, deemed as child abuse in the United States.

Despite myths about its prevalence among lower-income populations, child abuse occurs throughout all strata of society. Physical abuse does appear more frequently in poor families. Since middle-class and wealthy families are more likely to have their children treated by a sympathetic personal physician who may be less likely

Although these signs do not necessarily indicate that a child has been abused, they may help adults recognize that something is wrong. The possibility of abuse should be investigated if a child shows a number of these symptoms, or any of them to a marked degree:

Sexual Abuse

Being overly affectionate or knowledgeable in a sexual way inappropriate to the child's age

Medical problems such as chronic itching, pain in the genitals, venereal diseases

Regressing to younger behavior patterns such as thumb sucking or bringing out discarded cuddly toys

Sudden loss of appetite or compulsive eating

Being isolated or withdrawn

Inability to concentrate

Lack of trust or fear someone they know well, such as not wanting to be alone with a babysitter

Starting to wet again, day or night/nightmares

Become worried about clothing being removed

Suddenly drawing sexually explicit pictures

Trying to be "ultra-good" or perfect; overreacting to criticism

Physical Abuse

Unexplained recurrent injuries or burns

Improbable excuses or refusal to explain injuries

Wearing clothes to cover injuries, even in hot weather

Refusal to undress for gym

Bald patches

Chronic running away

Fear of medical help or examination

Self-destructive tendencies

Aggression towards others

Fear of physical contact—shrinking back if touched

Admitting that they are punished, but the punishment is excessive (such as a child being beaten every night to "make him/her study")

Fear of suspected abuser being contacted

Emotional Abuse

Physical, mental, and emotional development lags

Sudden speech disorders

Continual self-depreciation ("I'm stupid, ugly, worthless, etc.")

Overreaction to mistakes

Extreme fear of any new situation

Inappropriate response to pain ("I deserve this")

Neurotic behavior (rocking, hair twisting, self-mutilation)

Extremes of passivity or aggression

Neglect

Constant hunger

Poor personal hygiene

No social relationships

Constant tiredness

Poor state of clothing

Compulsive scavenging

Emaciation

Untreated medical problems

Destructive tendencies

A child may be subjected to a combination of different kinds of abuse. It is also possible that a child may show no outward signs and hide what is happening from everyone.

to diagnose and report injuries as child abuse, numbers reported may be biased. Even with such reporting bias, however, poverty seems strongly linked to abuse.

Child abuse is also linked to parental use of alcohol or other drugs. Several studies conducted during the 1970s confirmed that nearly 70 percent of substantiated cases of abuse were related to alcohol.

Anger most frequently triggers abuse by parents. Abusive parents appear to have a lower threshold for childish behaviors than nonabusive parents. The same child cues triggers more upset in abusive parents than in nonabusive parents. Most abusers are likely to have been abused themselves and generally resort to violence to cope with life stressors. Their abusive actions can be seen as subconscious reactions to an array of stressful aspects of parenting, including disappointment in the gender or appearance of a child; a jealous reaction to the attention a child diverts from themselves; an attempt by the abuser to hurt the other parent; or a reaction against the child for failing to meet unrealistic expectations.

Pedophiles, or sexual abusers of children, occur across all economic and cultural groups. Psychologically, however, they share certain traits . Pedophiles often have a history of being abused themselves, and abusing other children seems to be triggered by increased life stressors, such as marital problems, job layoffs, or abuse of drugs.

About 60 percent of the major physical injuries inflicted by caregivers occur in children ages birth to 4, the age group most likely to be injured from abuse.

Typically, abused children show developmental delays by preschool age. It is unclear whether these delays occur due to cumulative neurological damage or due to inadequate stimulation and uncertainty in the child about the learning environment and the absence of positive parental interactions that would stimulate language and motor processes. These delays, in concert with their parents' higher-than-normal expectations for their children's self-care and self-control abilities, may provoke additional abuse. Abused preschoolers respond to peers and other adults with more aggression and anger than do non-abused children. A coercive cycle frequently develops where parents and children mutually control one another with threats of negative behavior.

School-aged children who are abused typically have problems academically with poorer grades and performance on standardized achievement tests . Studies of abused children's intellectual performance find lower scores in both verbal and performance (e.g., math, visual-spatial) areas. Abused children also toward distractibility and over activity, making school a very difficult environment for them. With their peers, abused children are often more aggressive and more likely to be socially rejected than nonabused children. Less mature socially, abused children show difficulty in developing trusting relationships with others.

Within the home, abused children are more disruptive and aggressive, frequently viewed by their parents as defiant and noncompliant. Although observational measures confirm higher levels of disruptiveness, the number and intensity of the problem behaviors seen by abusive parents in their children may be partially a function of the parents' lower threshold of tolerance for children's noncompliance.

As adolescents, abused children are more likely to be in contact with the juvenile justice system than nonabused children of comparable family constellation and income level. Many of these children are labeled "ungovernable" for committing offenses such as running away and truancy. A higher proportion of abused than nonabused delinquent youth are also involved in crimes of assault.

Follow-up studies on abused children in later adolescence show that in addition to having problems with the law, they are also more likely to be substance abusers or to have emotional disturbances such as depression .

Over the last several years, many consider the number of child abuse reportings to be at epidemic levels. As reported in The CQ Researcher in 1993, "Almost overnight, the national consciousness has been jolted into confronting a disturbing possibility: Incest and child molestation may be far more common than previously thought." This increased reporting of sexual abuse has become a highly contentious topic among the psychological community and in the media as well. Many find the reports a reflection of a sexually disturbed society, while others believe that increased reporting is the result of sensationalist media accounts, celebrity pronouncements about their own abuse, and over-zealous therapists who too readily suggest to patients that episodes of sexual abuse may lay at the heart of their other problems.

Another disturbing trend shows an increase in reports of ritual abuse, or satanic ritual abuse (SRA), in which, it is alleged, children are systematically and repeatedly tortured by friends and family members in elaborate Satanic ceremonies often involving human sacrifice and ritual rape . Writing in The Journal of Psychohistory in 1994, psychoanalyst David Lotto reported that at a recent convention of the American Psychological Association , 800 therapists reported that they were currently treating cases of ritual abuse. A 1988 study conducted by University of New Hampshire researcher David Finkelhor found that as many as 13% of child abuse allegations occurring at day care centers involved ritual abuse. Another report followed the cases of 24 ritual abuse trials and found that 23 people had been convicted of some kind of abuse. In looking at this phenomenon critically, however, please note, as did an FBI investigator at a 1991 conference of the American Psychological Association, that in several years of intensive investigation by local and federal law enforcement, there has never been any evidence of a network of satanic child abusers. Victims often report the existence of elaborate underground sacrificial altars where their abuse occurred, and yet no trace has ever been found of such a construction.

Putting aside the current controversy over the prevalence of child sexual abuse in this country, no one disputes that sexual abuse does in fact occur and takes a devastating toll on those abused. Sexually abused children may still be preoccupied in adulthood with events, trying to understand and repair the damage. Frequently, sexual abuse is a cited cause, for instance, of dissociative identity disorder . Sexual abuse, like severe physical and emotional abuse, can lead to other psychological disorders as well, such as depression, mood disorders, anxiety and panic disorders, and substance abuse.

Further Reading

"Child Sexual Abuse: Does the Nation Face an Epidemic Or a Wave of Hysteria?" The CQ Researcher (15 January 1993).

Cockburn, Alexander. "Out of the Mouths of Babes: Child Abuse and the Abuse of Adults." The Nation (12 February 1990): 190.

Interview with National Committee for the Prevention of Child Abuse, April 17, 1996.

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Child Abuse

Dictionary of American History
COPYRIGHT 2003 The Gale Group Inc.

CHILD ABUSE

CHILD ABUSE refers to intentional or unintentional physical, mental, or sexual harm done to a child. Child abuse is much more likely to take place in homes in which other forms of domestic violence occur as well. Despite a close statistical link between domestic violence and child abuse, the American legal system tends to treat the two categories separately, often adjudicating cases from the same household in separate courts. Some think this practice has led to an inadequate understanding of the overall causes and dynamics of child abuse, and interfered with its amelioration.

The treatment of child abuse in law has its origins in Anglo-American common law. Common law tradition held that the male was head of the household and possessed the authority to act as both disciplinarian and protector of those dependent on him. This would include his wife and children as well as extended kin, servants, apprentices, and slaves. While common law obligated the male to feed, clothe, and shelter his dependents, it also allowed him considerable discretion in controlling their behavior. In the American colonies, the law did define extreme acts of violence or cruelty as crimes, but local community standards were the most important yardstick by which domestic violence was dealt with. Puritan parents in New England, for example, felt a strong sense of duty to discipline their children, whom they believed to be born naturally depraved, in order to save them from eternal damnation. Although Puritan society tolerated a high degree of physicality in parental discipline, the community did draw a line at which it regarded parental behavior as abusive. Those who crossed the line would be brought before the courts.

In the nineteenth century the forces of industrialization and urbanization loosened the community ties that had traditionally served as important regulators of child abuse and neglect. The instability of market capitalism and the dangers posed by accidents and disease in American cities meant that many poor and working-class families raised their children under extremely difficult circumstances. At the same time, larger numbers of child victims now concentrated in cities rendered the problems of child abuse and neglect more visible to the public eye. Many of these children ended up in public almshouses, where living and working conditions were deplorable.

An expanding middle class viewed children less as productive members of the household and more as the objects of their parents' love and affection. While child abuse did occur in middle-class households, reformers working in private charitable organizations began efforts toward ameliorating the problem as they observed it in poor and working-class families. Although the majority of cases brought to their attention constituted child neglect rather than physical abuse, reformers remained remarkably unsympathetic to the social and economic conditions under which these parents labored. Disadvantaged parents commonly lost parental rights when found guilty of neglecting their children. The parents of many institutionalized children labeled as "orphans" were actually alive but unable to provide adequate care for them.

In 1853 the Reverend Charles Loring Brace founded the New York Children's Aid Society. Convinced that the unhealthy moral environment of the city irreparably damaged children and led them to engage in vice and crime, Brace established evening schools, lodging houses, occupational training, and supervised country outings for poor urban children. In 1854 the Children's Aid Society began sending children it deemed to be suffering from neglect and abuse to western states to be placed with farm families. Over the next twenty-five years, more than 50,000 children were sent to the West. Unfortunately, the society did not follow up on the children's care and many encountered additional neglect and abuse in their new households.

Reformers of the Progressive Era (circa 1880–1920) worked to rationalize the provision of social welfare services and sought an increased role for the state in addressing the abuse and neglect of dependent individuals under the doctrine of parens patriae (the state as parent). In 1912 the White House sponsored the first Conference on Dependent Children, and later that year the U.S. Children's Bureau was established as the first federal child welfare agency. Child welfare advocates in the Progressive Era viewed the employment of children in dangerous or unsupervised occupations, such as coal mining and hawking newspapers, as a particular kind of mistreatment and worked for state laws to prohibit it.

The increasing social recognition of adolescence as a distinct stage of human development became an important dimension of efforts to address child abuse. Largely influenced by the work of psychologist G. Stanley Hall, reformers extended the chronological boundaries of childhood into the mid-teens and sought laws mandating that children stay in school and out of the workforce. Reformers also worked for the establishment of a juvenile justice system that would allow judges to consider the special psychological needs of adolescents and keep them separated from adult criminals. In 1899, Cook County, Illinois, established the nation's first court expressly dealing with minors. Juvenile courts began to play a central role in adjudicating cases of child abuse and neglect. Over the following decades the number of children removed from their homes and placed into foster care burgeoned. The Great Depression magnified these problems, and in 1934 the U.S. Children's Bureau modified its mission to concentrate more fully on aiding dependents of abusive or inadequate parents.

By the mid-twentieth century, the medical profession began to take a more prominent role in policing child abuse. In 1961, the American Academy of Pediatrics held a conference on "battered child syndrome," and a sub-sequent issue of the Journal of the American Medical Association published guidelines for identifying physical and emotional signs of abuse in patients. States passed new laws requiring health care practitioners to report suspected cases of child abuse to the appropriate authorities. The Child Abuse Prevention and Treatment Act of 1974 gave federal funds to state-level programs and the Victims of Child Abuse Act of 1990 provided federal assistance in the investigation and prosecution of child abuse cases.

Despite the erection of a more elaborate govern-mental infrastructure for addressing the problem of child abuse, the courts remained reluctant to allow the state to intrude too far into the private relations between parents and children. In 1989, the Supreme Court heard the landmark case DeShaney v. Winnebago County Department of Social Services. The case originated in an incident in which a custodial father had beaten his four-year old son so badly the child's brain became severely damaged. Emergency surgery revealed several previous injuries to the child's brain. Wisconsin law defined the father's actions as a crime and he was sentenced to two years in prison. But the boy's noncustodial mother sued the Winnebago County Department of Social Services, arguing that caseworkers had been negligent in failing to intervene to help the child despite repeated reports by hospital staff of suspected abuse. Her claim rested in the Fourteenth Amendment, which holds that no state (or agents of the state) shall "deprive any person of life, liberty, or property, without due process of law; nor deny to any person within its jurisdiction the equal protection of the laws." The Court, however, ruled that the Fourteenth Amendment protects citizens' rights from violations arising from actions taken by the state—not from actions it may fail to take. The boy had not been in the custody of the state, such as in a state juvenile detention center or foster home, when the violence occurred, and therefore, the Court said, no special relationship existed between the child and the state. In other words, children did not enjoy an affirmative right to be protected by the state from violence committed by their custodial parents in the privacy of the home.

Many advocates for victims of domestic violence criticized the ruling, arguing that it privileged the rights of abusive parents over the best interests of children, and worked toward reforming the law. The federal Adoption and Safe Families Act (ASFA) of 1997 established new guidelines for the states that included mandatory termination of a parent's rights to all of his or her children when the parent had murdered, committed a felony assault on, or conspired, aided, or abetted the abuse of any of his or her children. Laws in all fifty states require parents to protect their children from being murdered by another member of the household; failure to do so may result in criminal liability and loss of rights to other of their children. AFSA extended these liabilities to include a parent's failure to protect a child from felony assault. While the act's intent was to promote the best interests of children, critics have noted that this has not necessarily been the result. Prosecutors, for example, have been able to convict mothers who failed to protect their children from violence in the home even though they were also victims of the abuser. Thus, children have been taken from the custody of a parent who did not commit abuse and who could conceivably provide appropriate care after the actual perpetrator was removed from the home.

BIBLIOGRAPHY

Costin, Lela B., Howard Jacob Krager, and David Stoesz. The Politics of Child Abuse in America. New York: Oxford University Press, 1996.

Gordon, Linda. Heroes of Their Own Lives: The Politics and History of Family Violence, Boston, 1880–1960. New York: Viking, 1988.

Rothman, David J. The Discovery of the Asylum: Social Order and Disorder in the New Republic. 2d ed. Boston: Little, Brown, 1990.

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child abuse

The Columbia Encyclopedia, 6th ed.

Copyright The Columbia University Press

child abuse, physical, sexual, or emotional maltreatment or neglect of children by parents, guardians, or others responsible for a child's welfare. Physical abuse is characterized by physical injury, usually inflicted as a result of a beating or inappropriately harsh discipline. Sexual abuse includes molestation, incest, rape, prostitution, or use of a child for pornographic purposes. Neglect can be physical in nature (abandonment, failure to seek needed health care), educational (failure to see that a child is attending school), or emotional (abuse of a spouse or another child in the child's presence, allowing a child to witness adult substance abuse). Inappropriate punishment, verbal abuse, and scapegoating are also forms of emotional or psychological child abuse. Some authorities consider parental actions abusive if they have negative future consequences, e.g., exposure of a child to violence or harmful substances, extending in some views to the passive inhalation of cigarette smoke (see smoking).

In practice, there are borderline areas where what constitutes child abuse is not clear. For example, the U.S. Supreme Court has ruled (1944) that parents do not have an absolute right to deny life-saving medical treatment to their children, but devout members of the Church of Christ, Scientist, and other churches believe in the healing power of prayer and do not always seek medical help. Most U.S. states, however, permit parents to use religious beliefs as a defense against prosecution for the withholding of medical treatment from their sick children, even in cases where the lack of treatment results in a child's death.

Causes and Effects

There are many interacting causes of child abuse and neglect. Characteristics or circumstances of the abuser, the child, and the family may all contribute. In many cases the abuser was abused as a child. Substance abuse (see drug addiction and drug abuse) has been identified as a key factor in a growing number of cases. In some cases abusers do not have the education and skills needed to raise a child, thus increasing the likelihood of abuse, and providing inadequate parental role models for future generations. Children who are ill, disabled, or otherwise perceived as different are more likely to be the targets of abuse. In the family, marital discord, domestic violence, unemployment and poverty, and social isolation are all factors that can precipitate abuse.

Patterns of abusive behavior may result in the physical or mental impairment of the child or even death. Small children are especially vulnerable to physical injury such as whiplash or shaken infant syndrome resulting from battery. Abused children are more likely to experience generalized anxiety, depression, truancy, shame and guilt, or suicidal and homicidal thoughts or to engage in criminal activity, promiscuity, and substance abuse.

Intervention in Child Abuse Cases

In the United States, New York became the first state to institute child protection laws (1875) that made abuse against children a crime, and other states soon followed with similar laws. In 1974 the U.S. Congress passed the Child Abuse Prevention and Treatment Act, which encouraged remaining states to pass child protection laws and created the National Center on Child Abuse and Neglect. In addition, all states have their own reporting laws, juvenile and family court laws, and criminal laws.

Cases of child abuse are handled by an multidisciplinary team including medical personnel, law enforcement officers, the schools, social workers, and the courts. School personnel may be the first to notice and report signs of abuse. Child-abuse cases are often coordinated by a community's child protective services unit, which sends case workers to the home for evaluation and offers services to the child and family. Medical professionals may report cases, provide treatment for injured children, provide testimony in court, or help to educate parents. Law enforcement personnel may be involved when cases are reported or when there is a question of a criminal action. The courts provide emergency protective orders or decide whether the child should be removed from the home. Child abuse may be punished by incarceration of the perpetrator or by the denial of custody rights to abusive parents or guardians.

Incidence

Despite efforts to reduce child abuse in America, more than a million children are physically abused each year; about 2,000 die. Although the magnitude of sexual abuse of children in the United States is unknown, it is considered to be an escalating problem, and one that can result in serious psychological damage among victims. There are no reliable statistics available for emotional abuse and neglect, but these types of child abuse are as potentially damaging to their victims as are various forms of physical abuse. Child abuse extends across racial, ethnic, and socioeconomic lines, but there are consistently more reports concerning children born into poverty. The reporting of child abuse is complicated by the private nature of the crime, the fearfulness of the child, and strong motivation for denial in the abuser.

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child abuse

child abuse In its most general sense, child abuse refers to the maltreatment or injury of a child by an adult or adults. Such abuse can be physical, emotional, sexual, or a combination of all three. It might be perpetrated by one person or by several, within a family or outside it, and in public or in private. Child abuse is widely acknowledged as causing (often) severe emotional and psychological damage to victims, damage which, because of widespread imposition of secrecy by abusers, sometimes does not become manifest for many years. In this broad sense it points to an abuse of power between different age-groups. Historical evidence shows clearly that child abuse of all kinds has existed for centuries, although how it has been defined varies enormously. What was regarded as firm discipline fifty years ago is today considered abusive.

It is useful to differentiate physical abuse of children—child abuse or ‘baby battering’—from child sexual abuse. Baby battering became an issue of widespread concern and the basis for a moral panic in the 1960s, as discussed in particular by R. and C. Kempe in the USA (see their Child Abuse, 1983), who saw it as indicative of ‘dysfunctional’ families. Later investigations found that baby battering, as well as physical violence within families generally, correlated strongly with families living in poverty, although some contend that middle-class family violence is simply kept more hidden and secretive. The deaths in Britain of infants Maria Colwell in 1973 and Jasmine Beckford in 1984 created public outcry and raised controversial issues about what constituted appropriate interventions in families by social workers (see SOCIAL WORK).

In contrast with baby battering, which is apparently class-related, the evidence pertaining to child sexual abuse suggests that it occurs within all social classes. Most victims are girls, though boys are also abused. The majority of abusers are men, although there is evidence that a very small proportion of women also abuse children sexually. Collecting reliable data for child sexual abuse is notoriously difficult, particularly as most experts agree that the mojority of cases are never reported. Estimates range from 10 per cent to 90 per cent of all children having experienced some form of sexual abuse. One problem for researchers is that there is no single legal category of ‘sexual abuse’; it includes rape, buggery, unlawful intercourse with a minor, and incest (defined narrowly as the father having full sexual intercourse with a child). Much debate has focused on what exactly does constitute sexual abuse, and whether or not children can be trusted to tell the truth, particularly in court situations.

These issues came to the fore in a crisis in Cleveland (UK) in 1987, when over 200 children were reported by a paediatrician to have been sexually abused, but the local police, unwilling to accept such a possibility, refused to act on the doctors' evidence. Although it was later decided that some children had been wrongly diagnosed, evidence upheld the view that the majority of children had indeed been abused. At the time, however, it was the paediatrician and social workers, rather than the abusers, who were criticized. The episode resulted in widespread public debate about the role of the family in child-rearing, the nature of privacy and power relations in families, and balance between children's rights as against those of parents. Less discussed, but no less relevant, were issues relating to children as parents' property, male violence, and the erotic nature of some power relations (see B. Campbell , Unofficial Secrets—Child Sexual Abuse: The Cleveland Case, 1988).

There are three main models of child sexual abuse. The psychological model, which is concerned primarily with male offenders, sees the perpetrators as suffering from personality disorder. This model disregards the victims and the social context in which abuse occurs. The family systems model, by contrast, treats the family as a single entity, rather than focusing on the individuals within it, or the histories of particular family members. Families where abuse occurs are seen as ‘dysfunctional’. This view presupposes such a thing as a ‘normal’ family and implicitly labels families that do not appear to be normal as pathological or deviant. The feminist model regards sexual abuse as an aspect of a wider power system of male dominance over women and children, an integral part of which is male violence. Such a model recognizes inequality in general, particularly the abuse of power between age-groups, and presupposes different forms of intervention, but it does not offer any obvious solution for the minority of women who abuse children.

Good accounts of child abuse, which situate the phenomenon in its wider socio-political context, will be found in N. Parton , The Politics of Child Abuse (1985) and D. Gittins , The Family in Question (2nd edn., 1993) and The Child in Question (1997).

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child abuse

child abuse Emotional and/or physical (often sexual) maltreatment of a child. Neglect is considered a form of abuse. Physical abuse may be apparent in bruising and lacerations, burns or scars. Sexual abuse is often concealed by the abused either out of fear or guilt. Physical effects of sexual abuse may be apparent to a medical practitioner. Mental effects may result in remoteness or crudely violent outbursts. It is argued that victims of abuse are more likely to be abusers later in life.

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child abuse

child abuse (chyld) n. the maltreatment of children. It may take the form of sexual abuse, when a child is involved in sexual activity by an adult; physical abuse, when physical injury is caused by cruelty or undue punishment (see nonaccidental injury); neglect, when basic physical provision for needs is lacking; and emotional abuse, when lack of affection and/or hostility from caregivers damage a child's emotional development.

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